Monday 29 December 2008


They say that absence makes the heart go fonder. I don't know which "they" said this, and in all my cardiology lectures at med school I can't recall anything 'bout separation from meaningful folk being good for it, but it's said a lot so it must be true.

I've seen a couple of folk of late who've been with relatives over the Christmas period, having not seen them for a year.

On meeting up, one year on, it struck the family how their parent seemed less able to concentrate, a bit slower in their thinking and a bit worse in their memory.

To a one, they're all normal.

We know that as we get older (Primary Ageing) that memory does get worse, when assessed objectively using different scales and rating instruments. This intuitively makes sense, too. As we're older, memory gets a bit ropy, okay, I'll buy that, it fits with what we all see and kind of makes sense. This is different to a disease process affecting brain structure and function (Secondary Ageing) when, in dementia, the brain literally physically shrinks as bits of it are lost, so brain function gets worse.

It can be hard to tell the two apart. Memory is getting worse, is it just old age or is it a neurodegenerative disorder needing assessment and interventions? Sometimes a lot of investigation, radiological and radionucleotide imaging is needed along with longditudinal data over time before it's valid to say it's normal ageing or Mild Cognitive Impairement rather than saying it's definitely dementia.

The key difference between Primary Ageing and Secondary Ageing changes, though, is one of impact. In normal ageing, although neuropsychiatric testing shows memory getting worse, function is preserved. You can still find your way to the shops and back. When in the shops, you can still remember most of what you went for. When paying, if short changed from a £20 note, you'll notice.

We have less than perfect memory all the time. A friend who's a school teacher says normal kids, with perfectly young and healthy brains, have appalling memories. Lunches forgotten, pencil cases left, PE stuff not taken home and washed, coats and cardigans left on chairs. She has loads of stuff every day that evidence how the childrens' poor concentration, attention span and memory result in forgetfulness.

Yet they're normal.

Too, when my wife asks me to go to the shops for one thing, I'm usually fine. If she asks for a dozen, I'll make a list. If she asks for 5 or 6 things, I'll remember most of them most of the time but often will forget something. My memory's not bad, but I forget things.

We can edit out this background forgetfulness when seeing our family. It's easy to identify memory's not great, but harder to frame it as not great long term and a little bit worse, not great long term and worse with impact meaning they're not coping, not great long term and a lot worse recently and so on.

Which interested me, since it's odd how we look at things, then what we see (or what we see as important) isn't based wholly on the reality of what's before us.

Families spotted their parents' memories changed and sought help for them, which was all wholly appropriate. What was heartening was that their parents' memories were changing through physiological Primary Ageing but none of the folk of late have had clinical, neuropsychiatric or radiological evidence to support a diagnosis of dementia. Now that's a reason for seasonal good cheer!

1 comment:

Elaine said...

Welcome back, dear shrink - you have been missed.

Another cogent appraisal of the issues associated with loss of memory.