Esther Erickson, an eighty-three-year-old retired bookkeeper living alone, came with a long-standing friend and neighbor who had persuaded Esther that her memory needed to be checked. Esther had begun to forget names, locked herself out of her apartment a couple of times, and had accidentally left the stove on once. Other than a slight slowness in walking, there wasn’t anything unusual in her neurological examination, and her psychiatric assessment was completely normal. The rest of my diagnostic workup was notable for only two findings. Her memory was slightly below par, but otherwise she scored in the normal range for someone her age on the neuropsychological tests. Her
MRI scan revealed a very small stroke in the basal ganglia, which is a brain center that controls motor movements. This helped explain her slowness in walking but not her memory lapses.
Before I complete her story, put on your diagnostic hat for a moment. Is this normal aging? Is this mild memory loss? Or is this early Alzheimer’s disease? And where does “senility’’ fit into the picture?
Esther Erickson does not fit well into any diagnostic category. She is precisely the kind of patient who would have been rated as being on the way to “senility” if she had come to see a doctor fifty years ago. Nowadays, we don’t like to use the term senility because it blurs the distinctions between mild memory loss and dementia. Also, the old concept of senility implied that it was caused by hardening or blocking of arteries and their smaller branches. However, recent research has shown that age-related memory loss is usually not caused by diseases of arteries or other blood vessels in the brain.
A year later, Esther died suddenly of a heart attack. The brain autopsy showed no evidence of stroke other than in the basal ganglia, consistent with the clinical and MRI results. The only other abnormality was an occasional amyloid plaque without any neurofibrillary tangles. Amyloid plaques and neurofibrillary tangles, both of which are visible only under a microscope, are the pathologic features of Alzheimer’s disease. But with aging, an occasional amyloid plaque can appear even in the absence of any symptoms of memory loss. So while her autopsy told us that she did not have Alzheimer’s disease, we couldn’t rule out the possibility that it would have developed if she had lived for another five to ten years.
I think it is best to drop the term senility because it doesn’t tell us anything beyond the fact that the person is old and has memory loss.
Taken From: The Memory Program How to Prevent Memory Loss
and Enhance Memory Power
