Case Study

Case Study

By Robert Hill

Strategies for the Aging Brain
Coping with memory loss

I saw my barber, Ray, yesterday, and he asked me if I wanted the senior discount. "Ray," I said, "How old do you think I am?" He was polite. "I'm not sure, but if you want the senior discount, you need to ask for it." At a mere 54 years, I insisted on paying the full charge.

I'm a youngster when it comes to longevity, but my barber's misjudgment and my mildly deflated ego caused me to reconsider the markers many of us use to decide whether or not we're old. For Ray, appearance was everything. And to look at me—the not-so-subtle signs of balding, the gray beard, and the errant hairs protruding from my ears and nose—told him I was a card-carrying senior citizen.

What really concerns me, however, isn't my appearance, but the internal processes that tell me I'm old. The signs and symptoms of memory decay are hitting the radar screen of middle-agers at a higher frequency than ever before. Maybe it's because the 21st century expects us to remember more and do it faster, like the stream of computer passcodes or personal identification numbers, which keep growing in length and complexity. Maybe it's because, in an aging population, the media have discovered Alzheimer's with a vengeance, and we begin fearing its onset in every forgotten name or word.

According to the most recent 2010 Alzheimer's Disease Fact and Figures, an estimated 5.3 million Americans have Alzheimer's, including 200,000 persons under the age of 65. About 14 percent of Americans aged 71 and older have dementia, a broader label for memory diseases of aging, not specifically Alzheimer's—17 percent among women, 11 percent among men. Just because your mother or father didn't contract Alzheimer's disease doesn't mean that you're immune. The increase of average life expectancy puts even "long livers" into the high-risk category for memory impairment. The prevalence statistics increase in one's ninth decade, so if you yourself aren't afflicted with dementia when you're 80, the chances are that at least 20 percent of clients in their 80s will be seeking your help for it.

With this in mind, it isn't surprising that even "normal, age-related memory deficits" can strike dread into middle-aged hearts. Certainly, these maddening memory lapses dominate the lexicon of professional gerontology, and the proliferation of memory-disorder clinics signals a rising level of social concern, not to say panic, among the boomer-aged and older, generated by what are often euphemistically called personal memory slips.

Since our population is aging, memory decline is something middle aged and older clients are increasingly bringing to therapists. In fact, the first thing that most clients who make an appointment with me want is reassurance that they don't have brain disease. Once that issue has been addressed, we have to help them—whether or not they have a medical problem—understand that memory is like any other bodily ability: it shows the signs of natural aging. Finally, we need to engage them, gently but firmly, in a realistic program of memory training, making it clear that if they want to improve their skills at recall, they'll have to know it's important to always work at it. No therapist, no neurologist, no expert of any kind has a magic potion or intervention that'll miraculously recover for them the memory skills they had at 18 or 25, or even 35.

From Memory Slips to Alzheimer's

A few months ago, just after I'd concluded one of the positive-aging workshops I hold each summer, a tall, trim, keen-eyed, white-haired man came up to see me from the audience. He introduced himself as Steve and said he'd been pastor of his local congregation for nearly 30 years. He was on a first-name basis with his 228 regular parishioners. At age 72, in excellent physical health, he thought he could continue to lead his flock for at least another decade. However, he was deeply worried about persistent memory slips, which seemed to be worsening. He made jokes about his forgetfulness, but beneath his playfulness was an obvious fear that his problem might be an early indication of Alzheimer's or dementia.

Steve's worries were compounded by his lingering sense that his parishioners and their families were construing his intermittent forgetfulness—of their names and important dates—as a sign of lack of interest. His fear—that they might think he didn't care enough to remember their names—was so serious that he'd become less engaged with some of them. Even when I pointed out that his ministerial work made substantial demands on his memory, he remained anxious, becoming more so as we talked.

During his years as pastor, Steve had learned many coping strategies, which he artfully used to compensate for his declining memory. He'd leveraged his social skills so that he could convey interpersonal connectedness, no matter which member of his congregation he was talking to or what the topic of conversation was, even when his recall of specifics failed him. He also was becoming more dependent on his wife, since she helped him put names to faces in novel ways. During conversations at social gatherings and after church, she'd cleverly insert information to aid Steve's recollection. She might say, for example, "Steve, you remember that the Johnsons have that fishing camp out on the lake—Jake here is a champion fisherman, and Deanna is a wizard at cooking the catch." However, should he be without her when the talk veered in a direction requiring recall of personal details, he could find himself caught in a moment of forgetfulness so severe that he was forced to admit it and then apologize. It was clear that he was beginning to fear the worst.

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