Memory Loss: Can it be Cured? -- Majid Fotuhi, MD -- 6/26/03
By Majid Fotuhi
Memory loss is a frightening occurrence for anyone who finds the records of their lives fading away, whether it's minor forgetfulness or the devastating effects of Alzheimer's disease. We had a memorable discussion about preventing and treating memory loss with Majid Fotuhi, MD.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. Fotuhi. Is memory loss an inevitable part of aging?
Fotuhi: No. People may have slower rate of learning and memorizing things, but they should not lose their memory. Some degree of forgetfulness is normal with aging, but people should maintain the ability to function in their jobs and remember names of their spouses, children, friends, and so on. The only thing they should not forget is the names of their close relatives and their friends. That would be abnormal.
Moderator: How can one determine what is causing short-term memory loss?
Fotuhi: The most common cause of memory loss is stress and anxiety. The second most common cause is depression. The third most common cause is medical issues. Only the 10th or 11th on the list would be Alzheimer's disease. Ninety percent of older adults who complain about memory loss do not have Alzheimer's disease. Most of them have depression, stress, anxiety, fatigue, and lack of sufficient amount of sleep or medical issues.
Member question: What, if any, is the difference between dementia and Alzheimer's disease?
Fotuhi: That is a very good question. Dementia means memory loss plus deficit in one or more area of cognition, such as getting lost, confusion of time, or inability to do the usual hobbies a person may have. There are many causes for dementia, such as high blood pressure causing vascular dementia. The most common cause of dementia is Alzheimer's disease. So Alzheimer's is one of several different types of dementia.
Moderator: So what would be the first step a person should take if they feel they are losing their memory?
Fotuhi: The first thing they should do is to check the things I mentioned, such as stress, fatigue, lack of sleep, and most importantly, depression. They should discuss their memory loss with their physician. Most doctors can determine whether a person's memory loss is due to medical issues or if it is due to dementia. So check your causes of memory loss and talk with your doctor.
Member question: Dr. Fotuhi, my mother suffered a stroke at age 69 and since has developed vascular dementia. Having had a stroke myself at age 50 am I at a higher risk to develop vascular dementia?
Fotuhi: Yes. People who have vascular risk factors are at a higher risk or developing dementia. Having high blood pressure, high cholesterol, and high homocysteine all contribute to developing heart attacks, a stroke, and vascular dementia. Fortunately, all these risk factors are treatable and they should be treated aggressively. Once they are treated, a person is no longer at risk for developing dementia, especially if they start in their midlife.
Member question: I am a 52-year-old woman. How can I tell if the memory problems that I have been experiencing over the last year or so are some form of Alzheimer's or not? My grown children talk about events from their childhood that I just don't recognize. I also forget things as soon as I hear them and I lose words --I know what I want to say, but cannot remember the words. At times, familiar places become foreign to me and I can get lost or disoriented walking or driving.
Fotuhi: That is actually worrisome for dementia. However, the cause of dementia may be depression, which can be treated with medications, so I strongly recommend that you discuss this issue with your doctor.
Member question: I am 48 years old. I remember faces of students taught but not their names. Sometimes I scan my memory to remember something that has just happened but everything is blank. I call someone to pass on a message; by the time the person turns around (a matter of seconds) I have already forgotten the message to be passed. I had a surgical hysterectomy three years ago. Could it be the cause of memory loss? I tend to preserve the long-term memory but the short term one -- it's almost chaotic.
Fotuhi: Hysterectomy does not cause memory loss. The kinds of memory lapses you describe are very common. In other words, you may lose memory temporarily but you can retrieve that memory later. The kind of memory loss that would be concerning would be the type that the person would completely forget all the information. For example, it would be OK to forget the name of a movie you saw last weekend. However, it will not be OK for you to forget that you saw a movie at all
Again, there are many causes for short-term memory loss; the most common causes being stressful lifestyle, lack of sleep, anxiety, and depression. The chance that you have Alzheimer's disease in your 40s and 50s is extremely low. My advice to you is "forget about Alzheimer's."
Moderator: What is the usual age range for the onset of Alzheimer's?
Fotuhi: Alzheimer's disease is not as common as people think it is. Only one in 100 of those in their 60s develop this disease. Among those in their 70s, only two or three out of 100 develop Alzheimer's. The numbers are much higher only for those in their 80s and 90s.
Member question: I have memory loss due to an accident where I fell and hit my head. Amnesia. Can it be reversible?
Fotuhi: Head trauma associated with coma is one of the many risk factors for memory loss that comes with aging. However, other risk factors, such as high blood pressure, high cholesterol, high homocysteine, lack of exercise, lack of education, and depression, are more likely to contribute to memory loss than a single head trauma. If you did have a serious head trauma, you should focus on reversing your other risk factors, since you cannot reverse having had a head trauma.
You can also make sure that you prevent the chance of having a future head trauma for yourself and especially for your children by making sure that they wear their seat belts and wear protection for their head when they are involved in contact sports. It is very important to wear a helmet when you or your children are skateboarding, biking or especially of you're on a motorcycle.
Member question: Can menopause cause memory loss?
Fotuhi: There are a lot of controversies regarding menopause and memory loss. I think if a woman is experiencing her menopause and also having problems with her memory, she should check her risk factors and make sure that she has taken care of all her reversible causes of memory loss. For example, low thyroid levels are common and will need treatment. Taking hormone replacement therapy is now shown not to be effective, and it is also associated with increased risk of heart attacks, strokes, and breast and ovarian cancers. So the short answer is, check your reversible risk factors and try to maximize your memory ability by exercise and better diet.
Moderator: What is the role of exercise and diet in memory loss?
Fotuhi: Exercise improves memory in two ways:
Member question: What are these growth factors?
Fotuhi: One of them is called BDNF, which stands for brain drive neurotrophic factor. Another growth factor is called nerve growth factor or NGF. Both these growth factors have been shown to increase with exercise and to improve memory.
Member question: I am 55 years old now, have three grown children. I was treated for clinical and postpartum depression in my 20s with medication and ECT -- quite a bit of ECT -- over a period of five years, but not constant for those five years. Umpteen professionals told me that I would only have short-term memory loss and that it would return. Well, they either lied, mislead me, or did not know what they were relaying to me because ECT erased 98% of my memories of my children's childhood. Can you give me an honest answer as to why I lost my memories? Also, my memories of me growing up were erased. I live in the present and it is very upsetting to me that I cannot discuss my kids growing up with them. To say the least, I am angry and very sad.
Fotuhi: I appreciate how frustrating it must be to have a very poor memory. To the best of my knowledge, there is no formal study that has shown ECT to be associated with memory loss. I recommend that you discuss with your physician the other reversible causes for memory loss I mentioned earlier.
You may also need to have a brain MRI. Depression, as I mentioned earlier, is one of the main causes of memory loss. So the difficulties you have with your memory may still be due to depression. I think that you do need a full medical workup to identify the cause of your memory loss.
Member question: What vegetables/herbs do you recommend for helping progressive memory loss. Items that I can grow myself here in southern Texas. Assuming I can remember where I last left the shovel and hoe.
Fotuhi: I have a list of foods that are rich in antioxidants and vitamin in my book, The Memory Cure. I can give you a short list, and those include:
I also recommend two or three servings of fish a week. Several studies have shown that people who eat fish two or three times a week have a lower risk of developing Alzheimer's disease. You also need plenty of B12 and folate in your diet. Again, a complete list of these is on page 104 of my book.
Moderator: Let's talk about preventing memory loss. You mentioned foods. How about education and activity?
Member question: Do you agree with the "use it or lose it" philosophy for preventing memory loss, such as playing chess, reading, and doing puzzles?
Fotuhi: The answer is absolutely yes. Use it or lose it really applies to your brain as much as it applies to your muscles. Several studies in the past two or three years have confirmed this notion. People who do more crossword puzzles, play chess, or enjoy activities that require thinking, are less likely to develop Alzheimer's disease.
I often find it surprising on how well my patients do if they had a strong history of education and if they maintain an interest for learning. Even when they do develop Alzheimer's disease in their brain, they continue to function fairly well. Sometimes when we look at the brains of some of our participants in the Alzheimer's disease research center after they die, we find that they had Alzheimer's disease in their brain, but did not have any signs of dementia when we last saw them.
In summary, those who actively use their brains and enjoy hobbies and participate in volunteering activities, social activities and enjoy going to museums, going to the aquarium, or taking dance lessons do very well as they age.
Moderator: Can you address the issue of various herbs that claim to improve memory?
Fotuhi: The only vitamin supplement I recommend is vitamin E. I also strongly recommend to my patients and family to eat five pieces of fruits and vegetables a day.
The studies showing the effects of various herbs, such as gingko biloba are controversial. There are several studies now under way to once and for all determine the effectiveness of these herbs. My recommendation is that if you are taking these herbs and you do find them helpful, you can continue taking them. However, if you are considering which of the several different supplements to take, I recommend vitamin E and eating five pieces of fruits and vegetables a day.
Member question: How can the average person determine what is normal forgetfulness that comes with age and what is a sign of something more serious?
Fotuhi: There are several tests that help doctors distinguish between normal forgetfulness that comes with aging and the worrisome forgetfulness that is associated with a disease. My quick way of determining the difference is to ask my patients if they have stopped doing their routine activities because of memory loss. If they have stopped some of their hobbies or if they cannot complete their job responsibilities, I worry for their memory. Again, the cause of memory loss may be depression. Memory loss is not synonymous with dementia or Alzheimer's disease. I also have a list of questions on page 150 of my book to help people determine if their memory loss is significant and worrisome.
Member question: My 64-year-old husband has just been diagnosed with Alzheimer's and started on Aricept. Do you really think that Aricept can slow down the progression of this disease?
Fotuhi: There are several studies to determine whether any of the Alzheimer's medications slow down their progression of the disease. So far, none of the medications have made a significant difference in survival of patients with Alzheimer's disease. They are very helpful in reversing the symptoms associated with Alzheimer's and may reduce the progression of the disease to a small degree, but they are not the magic drugs that everybody would love to have.
Fortunately, there are at least a dozen new medications in different stages of development, which may, indeed, slow Alzheimer's disease and help patients tot fight the disease for many more years. I am very optimistic.
Member question: What do you know about memantine/Ebixa, which has been in use in Europe for 12 to 15 years? Will it be available in the U.S. soon? When? I have personal experience with it with friends and family members in Germany, and it has worked miracles in all cases. I was also able to obtain some for my stepfather who is in the moderate to severe range and it has turned life around for my mother who is the caregiver. Life has improved immensely and Dad has become more pleasant and helpful and considerate. His sister began taking it in 1995 when she began wandering from home, sometimes in the nude, going to the cemetery to talk with her deceased husband. Since being on memantine she caries on in a more normal fashion and "behaves" as a more normal, more pleasant and functioning person.
If this drug does work so well, why does it take our FDA so long to help people (and their caregivers) who are at the end of their rope already? In this case, why shouldn't Americans have the same opportunity to use a medication that makes daily life more bearable for both patient and caregiver?
Fotuhi: FDA has very high standards for safety of the medications that reach the American households. However, we expect memantine to be available in our pharmacies in the next few months, and definitely by January 2004. This drug is most helpful for patients in their mid to late stages of Alzheimer's disease.
Some of my patients do try to obtain memantine from Europe. I usually have no objection if they can obtain this medication. There are several other medications that are also under development and we should see a list of new medications in the next three to five years.
Member question: My aunt was diagnosed with Alzheimer's in her 50s, my uncle in his late 60s, and my father died from complications of the disease in his late 70s. Has it been shown that a genetic link definitely exists at this point, and if so are there any reliable estimates of how absolute that association is?
Fotuhi: People who have a family member with Alzheimer's disease are at a higher risk of developing this disease as well. However, it is important to keep the numbers in mind:
So the risk is doubled, which means 1%-2%. However:
So my recommendation to adults who have family members with Alzheimer's disease is to check their risk factors, which are:
If you answered yes to any of the above questions, you have the opportunity to lower your risk and make it less than those who do not have a family member with Alzheimer's disease.
Member question: Are the number of vascular dementia patients increasing or is it a direct result of people just living longer?
Fotuhi: That is an excellent question. The longer a person lives the higher will be his or her chance of developing dementia. Often people have a mixture of vascular dementia and Alzheimer's disease. If you live to be 120 years old, you have more than a 90% chance of being demented.
The goal of current studies is to find the best ways to postpone the onset of dementia. And several studies have shown that people who reduce their vascular risks during their midlife protect their brains against Alzheimer's when they get into their 80s and 90s. With the current trend toward preventing dementia, I suspect that when the current baby boomers reach their eighth or ninth decade of life they will be able to keep their brains sharp and develop Alzheimer's when they pass their 100th anniversary.
I think it is possible for people to be proactive to protect their brains and memories in the decades to come and ward off dementia until the very last year of their life.
Moderator: What should you do if you think a medication may be affecting your memory?
Fotuhi: There are many medications that cause memory loss as one of their side effects. Fortunately, there are different alternatives for each medication and if you think that starting a medication coincided with your memory difficulties, you can ask your doctor to consider an alternative medication.
Moderator: Dr. Fotuhi, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Fotuhi: People take it for granted knowing that eating hamburgers every day, constant stressing over minute details, spending weekends as a couch potato, smoking, and obesity increase the risk for developing heart attacks and strokes. Now there is a revolution in the field of memory research and Alzheimer's. The results of several studies in different countries all point to the fact that risk factors that cause heart attacks and strokes also increase a person's chance of developing Alzheimer's.
It is important for baby boomers to take an active approach to protect their brain against dementia. They need to check their list of risk factors and start doing it today. I recommend to people to stop complaining about their memory and start doing something about it. They have many opportunities to do so. If they want, they can read my book to learn all about it.
Moderator: Thanks to Majid Fotuhi, MD, PhD, for sharing his expertise with us today. For more information, please read his book, The Memory Cure: How to Protect Your Brain Against Memory Loss and Alzheimer's Disease.
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