Michelle Rupp: Hello and welcome to this week’s edition of AFMC TV. We’re so glad you’re joining us. Joining me today is Dr. Wei from UAMS. She is a geriatrician, and we are talking about common forgetfulness. Dr. Wei, thank you for joining me today. 

Dr. Jeanne Wei: Oh, thank you so much, Michelle, for having me. I’m delighted to be here, and I’m honored to be invited. Thank you.

MR: Thank you. So common forgetfulness, is that such a thing?

JW: Yes, there is very much such a thing, and I think it’s important for us not to be worried or scared. When we were younger, you know, in our twenties or thirties and we forget something, we would just dismiss it and say, “Oh, I forgot.” Then we would just keep on going and move on, and everything will be fine. But when we get to be older, we think, “I forgot. Is that terrible?” So, first, I want to reassure all of us. We all forget things when we’re older, just as we did in our teens and twenties. The first time I remember forgetting where I parked my car, I was in college. I didn’t think then that it was anything terrible. I still sometimes forget where I parked my car, but I’m wiser now. I park in the same spot.

There are other things that are very common that we forget, and then we worry about. For example, the first thing is we get distracted more easily. That is normal. We just need to focus, and there are certain things we can do to keep our focus. But no matter what, it’s easy to get distracted. That’s not anything except part of the way it is. We’re storing so much more information. Think about your computer. If there is more information stored in the memory, there is less room for the buffer. There is less free space for working.

MR: Yes. That’s a great analogy. So, when does normal forgetfulness becomes something that may need a little more attention?  

JW: Yes. So, for example, you may forget to pay a bill occasionally. We all sometimes forget because we’re in the middle of 18 different things. That’s okay! If we forget to pay a bill in succession, say it’s a monthly bill, and we didn’t pay it last month, and we forgot to pay it this month. If we forget to pay it next month, then we should think about it. Is there something? And the answer is yes.

If suddenly, we’re not able to do some everyday activities, that is something to consider. If we repeat ourselves, you know, we tell somebody a story, and we say, “You know, I just ran into Mary in the grocery store.” and then 10 minutes later, “You know who I just ran into at the grocery store? Mary!” That is another sign that we must think about.

We sometimes become disoriented to time or place. We may ask, “What time is it” or “Where are we?” That’s okay. If we keep asking and don’t remember that we already asked, that’s something that we should think about.

Communication is another thing. Sometimes we forget a word, or we are at a loss to what to say, or we forget someone’s name, and then later, at two o’clock in the morning, it comes to us. That’s common. But if it happens all the time, then we need to pay a little more attention.

Personality changes could also be an early marker. There could also be behavioral changes. For example, if we no longer want to change into day clothes from night clothes, we don’t want to bathe, or If we don’t want to comb our hair, those are things that should cause concern. It’s okay to lounge around. It’s okay to take a day off. We don’t always feel like getting dressed seven days a week, 52 weeks a year. But if we start to do that day after day and don’t want to bathe, we don’t want to brush our teeth, that is when we should start thinking about it.

Those are some of the signs of forgetfulness that are getting a little bit more advanced. We want to pay attention, take care of our loved ones, and be able to plan.

MR: Those are all great examples. I won’t call them red flags, but maybe pink flags. If you start to notice them, it doesn’t mean something is critical, but it certainly means you should begin to pay a little more attention. I want to ask where women are concerned, do hormones or hormonal changes factor into forgetfulness and memory loss?

JW: Yes. Now, this is a great question. Finally, in 2021, we’re starting to pay attention to the fact that we want to know why women, for example, manifest forgetfulness a little bit earlier. Why do more older women tend to have more memory loss than men? Why is that? According to current research, many women start to have changes in terms of forgetfulness earlier when they start to enter pre-menopause. We all think of menopause as occurring at around age 50 when menstruation has stopped for more than two years. I’m giving a plus or minus. It starts earlier, and we notice it, some of our loved ones and family and friends notice it, and it’s normal. It’s common, and be reassured that part of this is because of the hormonal changes. We will adjust and adapt, and we’re going to be okay. But, there will be a little bit of time when people are going to worry about us thinking, “Gee, what’s wrong with her?” But that’s because of the hormonal changes.

Now let me explain this a little bit more. Women have higher estrogen levels than men until they reach menopause. And then what happens is their estrogen level drops off. That differential dropping of the estrogen level is what affects our cognition. It turns out that postmenopausal women have a lower estrogen level than men. Now I know that’s a surprise for many people.

MR: What do you mean? Do men have higher estrogen levels?

JW: Yes, and they have it lifelong. And so, the estrogen that men have continues to benefit them and continues to protect their brains. What happens to postmenopausal women? They still have estrogen, but it’s much lower than it used to be. Most women are known for being able to multitask all day long, all night long, 24/7. You know, mom does everything, and mom’s still doing everything. That’s because the estrogen protects us and helps us. But once we go through menopause, we cannot multitask as much, and we do show a difference. Now. The question next is, what are we going to do about it? That’s something to think about. There is treatment, and it’s not terrible. We’re going to be able to adapt. We also need to keep a positive outlook and reduce the inflammation in our bodies. Estrogen is the coolest thing, but it has a limited duration. We need to be ready, and we must adapt. We’re going to be just as good, but we’ll just have to adapt it to it.

MR: That is so fascinating that it traces back even to some women who might be in their mid to late 30s or early 40s to begin noticing some of these cognitive changes.

Some of them are in public life. There have been a few examples of perimenopausal women. I would watch tv, and they would be talking. There would be halting in their sentences, and then what happens is they kind of fade away because they don’t want to embarrass themselves. But I can tell you that later on, it’ll come back. But there’s a phase that many women go through where they cannot finish the whole sentence without some pauses. Or there is a rapid succession of a few words, and then there’s a slow succession of a few words, and they’re embarrassed. But I promise most of the time, for most of the women, it will come back. It’s just because of the huge hormonal changes that we have to adapt to.

MR: Yes. Well, if I may ask one more question. We are quickly approaching the holiday season. We’re going to have many family get-togethers, opportunities to see loved ones. Are there any signs that adult Children might need to keep in mind when interacting with their parents? Perhaps they haven’t seen their parents in a year or more? As an adult, children are trying to ascertain where mom and dad are in their health journey? Any thoughts that they might want to tuck in the back of their minds as they are interacting.

JW: Yes. That’s very good, Michelle. I appreciate that question because it’s so critically important. The last thing we ever want to do is hurt our loved ones. And the last thing we ever want to do is stress our mom or dad or our older loved ones. What we want to do is be very gentle. I can tell you your mom or dad will be ready, and they’re going to be prepared to defend because they don’t want to acknowledge that you know they don’t remember or this or that. So, we have to be gentle and watch them and see what they do. If they repeat a whole lot, if they repeat a story several times, we have to note that. If they have some difficulty cooking the holiday food or have everything on the counter in the kitchen and somehow it doesn’t all get done, and we have to help, that’s a significant sign. It doesn’t mean that they’re going to go downhill from there.

There is a substantial number of people who have what we call mild cognitive impairment.  They do have some difficulty, but they’re not going to go on to continue to decline. They can stay there for quite some time. We want to help them the best we can. We want to be gentle. We want to look for those signs. But we don’t want to say things like, “Ma. You just told me that four times. You just asked me that question.” We are all guilty. I feel bad. The last thing we want to do is to make them feel bad. One thing to do if you already have a hint is just to be gentle. The important thing is to be with them where they are. In other words, it’s not fair to bring somebody who can’t remember and who can’t adapt today to make them try to come into our current situation. Things are changing so rapidly, and it’s easier if we go to them. There is nothing wrong with listening to the songs that they love and watching the programs they love. What’s wrong with that? Nothing. Okay. And that’s what we want to do. We want to be gentle. We want to be aware that mom or dad or uncle or aunt or anybody can show signs. Just be gentle and don’t rub it in.

The first time I visited my son, I was trying to pour some milk from a one-gallon jug, I didn’t aim it quite right. I spilled the milk a little bit on the table. He said, “Ma, I’m going to have to look for your nursing home now.” He was kidding. He’s a physician. But you’re part of it. Yes, you can joke, but don’t joke too much, especially if you notice that they are having difficulty. If they forget to put in the lettuce as part of the dish or make the whole salad, but something is missing, we take note. Don’t harp on it. Just keep going because it is okay.

MR: Excellent advice, Doctor Wei. Thank you so much for your thoughtful words and guidance as we navigate growing older.

JW: Yes, all of us, if we’re lucky.