Alterations in short-term memory are the hallmark of Alzheimer’s disease as well as a whole host of other brain changes that can, in time, erode our ability to make complex decisions such as handling finances or making legal documents.  The changes are subtle in onset and slow in progression.  Neither our own self-evaluation nor that of competent professionals can detect the changes by observation in the very early stages.  Despite our personal beliefs about our selves, most will not “know” when to give up the finances or when to stop driving.

 Changes in memory are not the province of medicine.  Medical screenings are insensitive to early changes in memory and brain scans produce too many false positive results.  Verbal learning tests used to assess short-term memory are better at detecting risk than are biomarkers such as PET scans. We need to refocus our efforts away from diagnosis.  A diagnosis of Alzheimer’s disease is demoralizing.  Monitoring memory is empowering.  There is so much you can do about changes in memory.  We need to detect changes and to monitor memory as comfortably and routinely as we manage our wellness.

I propose a simple plan.  There is no brief screening that will serve us well to protect our future.  These screenings are devised to detect Alzheimer’s disease, which is more than just memory loss.  Screenings are too insensitive and superficial.

I have given this quite a lot of thought as a result of my discussions with Tony Curatolo, Ciccarelli Advisory Services.  This is a plan that will be helpful to allow informed decisions regarding your ability to make complex decisions regarding medical, financial, or legal matters:

  1. We all need baseline memory evaluation that is friendly, thorough, and affordable.
  2. The assessment should consist of an interview that is structured around memory, verbal problem solving, and speed of thinking.
  3. The assessment should directly involve family members (involved in all aspects of the assessment) and include detailed feedback on how your brain is working (strengths as well as weaknesses).
  4. I suggest the following components of the basic evaluation for someone without noticeable concerns: a quantifiable checklist (also completed by someone who knows you well) on the present state of your brain, a verbal learning test, a paper and pencil arithmetic test, a measure of speed of thinking, a measure of verbal problem solving, and a global index of confusion.
  5. This evaluation is very much like routine blood work or monitoring your investments.  It provides quantifiable scores and feedback that you can follow over time to monitor progress and to anticipate future needs.

I have developed such an evaluation that I plan to make available in the near future.   Be proactive with your memory just as you are with your health, finances, and legal directives.  The best strategy for beating Alzheimer’s disease is to proactively manage and monitor your memory.