Memory Worries May Be Early Sign of Alzheimer's

Older adults who notice new problems with balancing the checkbook or reading the newspaper may be at increased risk of dementia in the coming years, according to four new studies.

                                    

The research, being presented this week at the Alzheimer's Association International Conference in Boston, suggests that older adults' concerns about their memory could serve as an early warning sign of future dementia.

That may not sound surprising. But it has not been clear whether people's subjective perceptions of memory slips are a reliable predictor of more-severe problems down the road.

Older adults who complain of memory issues, but test "normal" on standard cognitive (thinking) tests, have often been dismissed as the "worried well," said Rebecca Amariglio, a neuropsychologist with Brigham and Women's Hospital in Boston who led one of the new studies.

Her team found evidence that older adults' concerns may be more significant.

The study included 131 adults who were 73 years old, on average, and had normal scores on formal tests of memory and thinking. To get at the participants' subjective perceptions, the researchers gave them a separate, detailed questionnaire that asked them to rate any problems they had with everyday tasks, like remembering things they've just read or been told. It also asked them how well they thought their mental skills measured up compared with a decade ago.

Next, the researchers used PET scans to image participants' brains.

It turned out that people with bigger subjective concerns about their mental sharpness had a higher level of beta-amyloid proteins in the brain. Beta-amyloid buildup is considered a risk factor for Alzheimer's.

It's not known yet whether the study participants who were worried about their memories actually face a greater Alzheimer's risk, Amariglio said.

She also stressed that older adults need not be alarmed by the "senior moments" that crop up as you age -- like walking into a room and forgetting why you went there, or having trouble remembering an unfamiliar person's name.

An expert not involved in the study agreed.

"We're not talking about those times you walk out of your house and realize you've forgotten your keys," said Heather Snyder, director of medical and scientific operations for the Alzheimer's Association.

"We're talking about cases where you identify a change over time -- you've always been able to balance your checkbook with no problem, but now you're having difficulty," she explained.

Even those issues do not necessarily mean you are on a course to develop Alzheimer's or other forms of dementia. But if you notice such changes, it is something to bring up to your doctor, Snyder said.

Three other studies presented at the meeting uncovered evidence that subjective memory concerns may serve as red flags:

In a study of nearly 3,900 U.S. women aged 70 and up, those with memory concerns were more likely to show declining scores on objective memory tests over the next six years. The link was most clear among women who carried the ApoE4 gene variant -- the strongest known genetic risk factor for Alzheimer's.

Another study followed 531 older adults who took annual cognitive tests for a decade. Before each test, they were asked if they'd noticed changes in their mental abilities in the past year. Those who said they had were twice as likely to be diagnosed with mild cognitive impairment or dementia at some point during the study. On average, participants noticed changes six to nine years before their diagnosis.

German researchers found that of 2,230 elderly adults who were free of obvious impairment, those who thought their memories were getting worse showed a steeper decline in objective memory tests over the next eight years.

The findings all raise the possibility that evaluating memory complaints could help doctors spot older adults at increased risk of dementia. But Snyder said it's too soon to say for sure.

"We don't know yet how this all could be used as a potential tool," Snyder said.

Amariglio agreed. She said the questionnaire from her study is not ready for doctors to use in everyday practice. Instead, it might help researchers find candidates for ongoing clinical trials that are studying drugs or lifestyle measures to hopefully slow down Alzheimer's progression.

Right now, there is no known way to prevent or delay Alzheimer's. But if researchers do find such a therapy, Amariglio said, a questionnaire that helps spot older adults at risk would become very important.

For now, Snyder recommended that older adults who notice changes in their mental acuity tell their doctors. "If there's a concern, you can be further evaluated," she said.

Alzheimer's disease is the most common form of dementia, and experts estimate that if no progress is made in delaying or preventing the disease, the number of Americans with Alzheimer's could triple by 2050, to nearly 14 million.

Along with the emotional toll for families, there is the cost of caring for people with Alzheimer's. A recent study estimated that in 2010, the United States spent up to $215 billion on care for people with Alzheimer's and other forms of dementia.

Because the new studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.