In fact, among people 45 and older who have concerns about their memory, only about a quarter brought them up with a health care professional. The findings come from more than 10,000 responses across 21 states to the CDC’s 2011 telephone survey the Behavioral Risk Factor Surveillance System. One in eight people 45 and up said they were concerned about the memory problems they’d been having, but only 23% talked about them with a doctor. Even among people who said those memory problems consistently interfere with daily activities like completing chores or finishing work, only 51% said they’d talked to a pro about memory problems.
There are a couple of viable theories as to why this might be, according to the report’s author, consultant Mary Adams, of On Target Health Data LLC. For starters, older people were less likely to have discussed memory problems with their doctors. “I wonder if they think these are normally occurring problems,” she says. “As they get older, maybe they think there’s nothing that can be done about them.” Or maybe timing’s to blame: People who had gone in for a routine checkup over the last year were more likely to have discussed memory problems than people who hadn’t had an appointment in a while. Certainly, routine checkups provide an opportunity to start these tricky conversations, and the more time a person spends face to face with their doctor, the more opportunities they have to talk. Indeed, people who said they weredepressed or had any disability were more likely to have discussed memory problems, whether that’s because they’re more comfortable talking about their health or simply have more interactions with docs, Adams says.
While a routine checkup is a good start, it’s not necessarily the solution. “If people are only seeing their doctor once a year, they may have other issues they need to bring up first,” Adams says, leaving little time to discuss where you last remember having seen your keys.
So how do you know when you should actually muster up the guts to talk to your doc about those little slip-ups? Cognitive assessment tools may help. Douglas Scharre, MD, a professor of clinical neurology and psychiatry at The Ohio State University Wexner Medical Center and colleagues created just such a tool, called SAGE, or the Self-Administered Gerocognitive Exam.
Easy to do almost anywhere, the SAGE test can be downloaded and printed from your own computer, completed before a doctor’s visit, and handed in at the appointment for scoring and discussion. Receptionists could hand it out in waiting rooms; concerned spouses, siblings, or children can propose it at home. While the test looks relatively simple, Scharre explains it was challenging to create the perfect balance of questions to equally measure different brain functions, like memory, language, and visual and spatial skills. It’s not perfect, he says, but it’s a starting point. “It tells us if maybe there’s something going on with the brain that a doctor should investigate,” he says. “It starts the conversation a lot earlier.”
The earlier the better, considering our current medications for dementia only slow the progression of the disease. “The longer you delay, the more your brain is ravaged, the more brain cells have died, never to return,” Scharre says.
When he and his team published the test in its current form in 2014, there were over a million downloads in 6 months. “I think people want to do something to help their brains, but they tend to avoid bringing those issues up,” he says. He cites a number of potential causes of that silence, from simple embarrassment to a lack of insight in people struggling with true dementia symptoms. Like Adams, Scharre also says older patients tend to normalize their slip-ups. These patients are the ones rushing out the door saying things like “Doc, I’m 74, everyone complains of memory problems, I don’t think it’s a big deal, and you’re a busy person, I don’t want to waste your time.” In reality, though, “you may have it a lot worse than everyone else, even though everyone complains about it,” Scharre says.
Since it’s pretty convenient, there’s no harm in taking the SAGE test even if you probably don’t need to be concerned about your memory. In fact, Scharre says, “one of the best uses of this test is to relieve fear for the ‘worried well.’ ” Forgetting the name of the actor in that movie you watched last week, he says, is probably totally normal—and the questions posed by the SAGE test will immediately comfort you if your memory concerns are of this nature. Although you can get a pretty good grasp of your results just by perusing the SAGE website, a doctor can help explain what those results mean, so Scharre recommends bringing it with you to your next appointment if you’ve filled it out at home. Then your doctor can hang onto your results as a baseline and keep an eye on any changes if you’re still not entirely reassured. Change in your score over time will be more important than the particular score itself, he says, since everyone has a different level of education and set of skills going into the test.