One of the trials of pushing seventy is having frequent interactions with contemporaries and their older associates who are clearly suffering from memory impairment. Some of them have been diagnosed with Alzheimer’s disease or some other form of dementia; others are still considered normal but are behaving in ways that suggests a decline in function. My perception of rising frequency is no doubt exacerbated by having a wide circle of acquaintances with a history of alcoholism and drug abuse. My own short-term memory is still, by the grace of God, in fine shape – I could hardly have gotten an A- in first year Latin this spring if it were not.
There is a condition that has been long recognized among chronic alcoholics, Korsakoff’s syndrome, in which the sufferer is unable to process new memories. Oliver Sachs describes a dramatic case in which a man suffered severe amnesia following a binge in 1945. He recovered partially, but some years later lost all memory of the intervening years and had to be institutionalized, for although on a short-term basis he could function and interact with people, he had no memory of recent events. I recall this case when I am interacting with people with a history of alcoholism, who are currently sober or at least claim to be, and who nonetheless appear to be suffering blackouts. At first I assumed they were deliberately lying, but now I wonder if advancing age has reawakened old neurological deficits.
A characteristic of sufferers from Korsakoff’s syndrome, one which makes them difficult in any personal or professional interaction, is confabulation . That is a tendency to invent a story to fill in the missing memory gap, based on what the person thinks the audience wants to hear and what is most advantageous to the teller at that moment, and then to believe that story as true, even in the face of evidence that it is not. Confabulation can resemble pathological lying, but it is different, and more insidious, since the originator is unaware that he or she is not telling the truth.
People with Korsakoff’s syndrome can be very suggestible and easily manipulated. This is also true of people with other undiagnosed memory disorders who are clinging to autonomy by denying and covering up their deficits. The susceptibility of elderly people to financial scams – for example, claims that they have entered into a contract of which they have no memory – is notorious. The existence of a large bloc of voters with similar deficits unrecognized by society at large and unacknowledged by the individuals themselves, but recognized and exploited by political candidates and special interest groups, cannot be good for the health of a democratic state.
So far I have addressed two causes of memory deficits which afflict a large number of people in my “baby-boomer” generation – lingering effects of alcohol and drug abuse and spongiform encephalopathies such as Alzheimer’s disease. Other causes which are certainly quite common are nutrient absorption problems due to age and prescription drug side-effects.
The AARP site lists a number of very common drugs that adversely affect memory, including . Antianxiety drugs, Cholesterol drugs, Antiseizure drugs, Antidepressant drugs, Narcotic painkillers, Parkinson’s drugs and Hypertension drugs, and cautiously advises that people who have been put on any of these long-term, have no acute need, and are experiencing memory loss consider alternatives. The number of people over 60 who take one or more of these medications in the U.S. is staggering. The number who have recognized clinical symptoms that cannot be attributed to other causes is but a small fraction of the people who might be sufficiently affected to influence the collective political and social consciousness in ways that undermine individual and collective well-being but enrich a dwindling elite. A person with a defective memory will not, for example, remember his former symptoms sufficiently to realize that there has been no net improvement, and will agree with the physician claims there has been, and dispenses another aliquot of medications.
Alcoholic Korsakoff’s syndrome results from a combination of decreased intestinal absorption of B-vitamins due to damage to the digestive system and primary malnutrition due to a very poor diet. The prevalence of Wernicke’s encephalopathy, Beriberi, and Pellagra in this population has a similar etiology. All of these conditions can produce dementia, as well as physical manifestations.
Intestinal absorption tends to decline with age, which is one reason elderly people need to be particularly conscious of their diets, and why subclinical deficiencies in everything from B-vitamins to calcium and protein rear their ugly heads in the elderly. Some medications, notably proton pump inhibitors, also exacerbate poor nutrient utilization, as do autoimmune disorders and chemotherapy. There is the potential for a destructive feedback loop here, with dietary deficiencies causing memory deficits and memory deficits having a deleterious effect on eating habits. If both the older patient and the attending physicians fail to explore a dietary connection (and this commonly happens) but instead opt to prescribe drugs which only relieve symptoms and may actually cause the underlying condition to worsen, the prospect for an exponential process is obvious. For example, racing pulse and heart arrhythmias are a symptom of Beriberi, which is caused by thiamine deficiency and effectively treated, if not by diet alone, by IV administration of thiamine. Some heart drugs inhibit intestinal absorption and resorting to surgery to correct co-occurring vascular blockages that are not responsible for the symptoms exposes the patient to all the hazards of heart surgery (including an increased risk of Alzheiner’s disease) without addressing the root cause.
I am currently dealing with a situation and conflict with an older individual whose approach to life seems to include a substantial degree of confabulation that inhibits him from dealing with pressing dilemmas. I observed that the behavior looked alcoholic. The man is to my knowledge not drinking or using streets drugs now and has not for a number of years; for the reasons outlined above I’m not certain I believe him when he claims he has never abused alcohol or drugs. A mutual friend observed that she thought he might be developing Alzheimer’s disease. Both are possible and not mutually exclusive. It gives me pause to consider that this man is by no means an unusual case, but is symptomatic of a large birth cohort approaching old age with a marketplace poised to capitalize on this and inadequate resources to feed that marketplace, even for care that has a reasonably good track record.
Photo courtesy of Martha Sherwood