There is a word that has long been used to describe elderly people who become confused or forgetful: it’s “senile,” and it comes from the condition known as “senile dementia.” But just what qualifies as senility or dementia? When does forgetfulness become a truly worrisome and progressive condition?

“Dementia” is a blanket term for a decline in intellectual functioning severe enough to interfere with a person’s relationships and ability to conduct daily activities.

Dementia is a major cause of cognitive failure—a breakdown in the process by which knowledge is acquired, retained, and used. About 15 percent of persons over age 65 have some form and degree of cognitive failure.

Alzheimer’s disease is the most common cause of dementia among older people, but there are others. Multi-infarct dementia can result from several small strokes. It produces similar effects but is not progressive. Age-associated memory impairment is a decline in short-term memory that sometimes accompanies aging. It does not progress to other mental impairments as Alzheimer’s disease does. In other words, there are many conditions that share the early symptom of forgetfulness, but their outcomes are quite different.

If you have concerns about your memory, or that of a loved one, tell your doctor. Because no laboratory test can reliably establish a definitive cause of cognitive impairment, an evaluation will usually be based on medical history and physical examination and the use of various neurological tests.

There are a number of treatable conditions that can cause poor memory, including thyroid gland disorders, medication side effects, depression, stroke, head injury, or brain tumors. In most cases, doctors can rule out dementia and treat the reversible causes of memory loss. They can also make a clearer diagnosis of irreversible dementia and help patients develop strategies to preserve function and independence.

SOURCE: The Merck Manual and Harvard Women’s Health Watch, July 1999

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