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Ask the Mental Health Expert Archives 2001-2004

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Q. My grandfather is over 70 and he is getting forgetful. How can you tell when the forgetfulness is serious, or if it's dementia? He is able to recall specific details of his time in the military and being on a farm as a kid, but when he is asked about something that just happened (like: where did you put the newspaper?), he gets angry and I think it's to cover up that he really doesn't know. Why does this happen?

A. You are facing a difficult issue that many of us with elderly loved ones are also confronting. While I can't give you specific advice about your grandfather, here is some background material.

First off, not remembering where you put the newspaper, or the car keys, is very common in all age groups. By itself, this would not raise fears of a dementing illness, such as Alzheimer's Disease (AD). However, when the individual begins to experience difficulty recalling the names of familiar friends or relatives; frequently needs to be reminded of what was said only a few hours ago; seems confused about where he or she is, or has been in the past few hours; or shows difficulty in managing everyday tasks that he or she has done easily for years (such as balancing a check book or tying a tie), then there is reason for concern.

When memory disorders do occur in old age, they often affect more recently acquired memories. For example, individuals with dementing illnesses may recall their fifth-grade school teacher very clearly, but be unable to remember what they had for breakfast. This is often very embarrassing to the person, and he or she may react with either anger or defensive humor. Not all dementing illnesses are due to Alzheimer's Disease, though this is by far the most common cause of dementia in the elderly.

Sometimes, a deterioration in memory may be due to a nutritional deficiency, or a blood clot on the brain. Poor memory may also be seen in non-dementing disorders, such as major depression. I would suggest that you try to get your grandfather to see his or your family physician for a check-up. If possible, try to get someone in the family to accompany him, so that that family member can alert the doctor to the problem. You don't have to say, "We're worried that Grandpa has Alzheimer's Disease". You can just indicate that you've noticed that Grandpa seems to have more trouble remembering things lately, and let the doctor take it from there.

At some point, it might also be useful to have your grandfather seen by a specialist in geriatric psychiatry, ideally, as part of a consultative process with your family physician.

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October 2001

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