Guest Article

Understanding Everyday Forgetfulness and Cognitive Changes in Aging

Kim Scott, LMFT

Clients often worry about memory lapses, like forgetting why they walked into a room or turning the wrong way when heading to the doctor’s office or Pilates class. These instances are normal aspects of everyday forgetfulness and not signs of cognitive decline. Yet, when I turned 65, I also worried that these lapses signaled the beginning of Alzheimer’s. 

Why Does Everyday Forgetting Happen?

Everyday forgetfulness is a common experience unrelated to age. People of all ages experience these lapses, but stereotypes about aging—such as referring to these memory lapses as “senior moments”—can often lead people to jump to the wrong conclusion.  Normal forgetfulness can be caused by a variety of factors, such as distraction, stress, fatigue, or multitasking. Worry, depression, and lack of sleep can also contribute. However, there are some cognitive changes that are normal with aging, but these changes seldom impact the individual’s activities of daily living.

Types of Cognitive Impairment in Seniors

Other types of forgetting or cognitive impairment can be cause for concern. Cognitive impairment is a catch-all phrase encompassing various issues that affect a person’s ability to think, process information, or concentrate. It can range from mild impairment that is only noticeable during complex tasks, to severe, where an individual loses all verbal abilities and requires assistance with daily activities.

Cognitive impairment can be temporary, persistent, pervasive, or progressive.  The most common causes of cognitive impairments among seniors are the 3 D’s: delirium, dementia, and depression. Other factors such as medications, medical conditions, anxiety, and isolation can also lead to reduced cognitive functioning. Mild cognitive impairment is a transitional state between normal aging and dementia. 

Dementia can range from mild to severe and is irreversible and degenerative. Our hope is that through medical interventions the individual can slow the progress of decline. In the DSM-5, these disorders are categorized within the section on Neurocognitive Disorders. The term dementia is often used when the individual is experiencing memory impairment in several different areas, such as:

• Retaining new information
• Forgetting how to complete activities of daily living
• Forgetting loved ones
• Experiencing difficulty completing motor activities
• Decreased executive functioning

Alzheimer’s Disease is the most common cause of dementia.  Parkinson’s is the second most prevalent neurodegenerative disorder in seniors.

Whereas dementia is often a progressive, gradual decline, delirium develops rapidly, often over days or even just hours. It may involve a disturbance in attention, memory, language perception, or disorientation and can fluctuate throughout the day. Depending on the cause, delirium can be reversible if caught quickly.

The Global Deterioration Scale provides detailed information on the various levels and types of cognitive decline that seniors may experience. As therapists, this is a good place to start when a client or family is describing concerns. It will help you distinguish between very mild changes and severe decline.

It is important to remember that depression can mimic cognitive decline, but once the depression is treated, the cognitive impairment recedes. Depression and anxiety can also co-exist with other forms of cognitive decline, as a change in mood is often one of the symptoms of dementia. In fact, a study done by Teri and Wagner (1992) found that approximately 30% of individuals with dementia also meet the criteria for a diagnosis of depression.

Understanding these distinctions can help therapists accurately assess the challenges their clients are facing with greater clarity and compassion, ensuring that their clients receive the appropriate care and support.

Assessment

The first step is a full assessment. This is extremely important because some causes of impairment may be reversible. A full assessment should include:

• A bio-psycho-social interview. Have your client share details of how and when they experience cognitive difficulties. Also, include a strengths assessment and remember to evaluate for depression. The Geriatric Depression Scale is a useful tool in checking for depression in seniors (developed by Yesavage et al., 1983).
• A family interview if possible, to provide additional insights.
• A medical evaluation, including a medication review.
• If no medical causes are uncovered, a neurophysiological and functional assessment may also be useful.

Therapeutic Treatment

Psychotherapy can be useful for clients with mild cognitive impairment and mild dementia. In addition to providing a place for the client to grieve their losses, the therapist can also help their client:

• Take a solution-focused approach by identifying problem areas and developing solutions, workarounds, or “memory hacks.” For example, helping a client who forgets to take their medication schedule reminders in their phone, purchase a special pillbox that notifies them when it is time for medication, use the good old-fashioned sticky notes, or enlist a family member to help.
• Take stock of your client’s strengths. Help your client identify times when the problem is not present so that they can move away from globalizing or catastrophizing. Identifying when a problem doesn’t occur can also help the client determine if other factors are intensifying the forgetfulness, such as being tired or stressed.
• Use behavioral strategies, such as helping your clients establish a predictable routine and structure to their day, which can help the person remember routine tasks. Repetition and practice are other examples of behavioral strategies.
• Environmental modifications, such as having your client decrease the clutter in their house and creating other easy organizational systems. For example, one client had a difficult time processing their daily mail. We came up with a plan to only touch each item once and either throw it out, put it in a red file for bills to be paid, or a blue non-urgent file for information they may want to review later.
• Teach stress management skills and suggest daily practice.
• Encourage social interaction, support groups, and senior centers as excellent resources to help clients keep their minds active and engaged.
• Provide psychoeducation about the importance of a balanced diet, regular exercise, and sufficient sleep. Regular exercise actually increases blood flow to the brain, which can improve all cognitive functioning.
• Enlist family support and understanding.

Sadly, too many clients have told me that their doctors brushed off their concerns as just part of being old. It is important to remember that even if we can’t turn back certain types of brain functioning, we can help our clients optimize the strengths and abilities they do have.

Kim Scott, LMFT is a licensed marriage, family and child therapist. She has a private practice in Granada Hills where she works with couples and individuals, in-person and via Telehealth. Kim has been licensed for 30 years and has expertise in working with older adults and women issues. To learn more about Kim's practice and to read more of her articles visit her website: www.kimscottmft.com