A friend repeats herself — is that a problem? How to recognize and talk about memory issues

Editor's Note: An excerpt of this interview ran in WBUR's weekly health newsletter, CommonHealth. If you like what you read and want it in your inbox, sign up here. 

There’s a wave of dementia coming, as America’s population ages.

Promising treatments may slow the effects if problems are diagnosed early, and researchers are testing ways to stop the condition before it sets in. But talking to friends and family members about the signs of dementia has always felt like one of those third rail topics.

These days though, I’m having more and more experiences where a friend or loved one can’t remember an event we all attended, or they repeat a story, or they can’t recall the name of an actor in the movie they just saw.

Are these all normal signs of aging? Or are they red flags that signal it’s time to see a doctor?

For answers, I called Dorene Rentz, a neurology professor at Harvard Medical School who’s been seeing patients as a clinical neuropsychologist for more than 35 years.

Rentz found herself asking some of these same questions about 10 years ago. Her son wanted to borrow the camera he’d given his parents, but Rentz’s husband insisted he’d never received it. Rentz had seen other reasons to worry about her husband’s memory. She helped him enroll in a clinical trial that ended in 2022.

Here’s a condensed version of my conversation with Rentz. It’s been edited for length and clarity.

First, can you please clarify the difference between dementia and memory-related illnesses like Alzheimer's?

“Dementia is the broad condition that includes diseases like Alzheimer's, vascular dementia, Lewy Body and memory problems that can develop during Parkinson’s.

“Every case of dementia has a stage. It might be mild cognitive impairment, which is prior to dementia, or dementia that is mild, moderate or severe.”

How can we tell the difference between memory lapses that seem to be more common as we age, and dementia?

“Memory is embedded in stages. When you learn something, it’s encoded and then consolidated in your brain. Usually we can pull that information out in a timely manner. That stage is recall or retrieval. If it sticks over time, that’s called storage.

“In normal aging, it’s not unusual to have problems recalling something, but if someone offers a clue or reminder, the memory emerges. With dementia, the information is never fully consolidated, so you can’t retrieve it and may say you never heard it. That helps explain why people repeat themselves — they don’t recall that they said or heard something. [With dementia] you are constantly forgetting what you heard because the information doesn’t stick.

“Women sometimes worry they are in an early stage of dementia during menopause because the hormone changes interfere with recall. But those effects go away — but [they] may return during the aging process.”

What are some common signs that warn of dementia?

“Forgetting an event almost as soon as it happens or details from important conversations. Getting lost in familiar environments, like a mall the person has been to many times. 'Mom made the same lasagne recipe for years, now she can’t remember how.' 'Dad doesn’t recall his Aunt Celia, a close family member he has not seen recently.' ”

When should we have a conversation about what we’re noticing? I have some friends, for example, who wait until they think their parent or friend is no longer safe at home, in public or driving.

“You want to have the conversation in person, while the person is still fully aware of their situation. If the disease progresses, your family member may be in denial, and that’s much harder to address. And treatments that can slow the progression of the disease work well early on. If you wait until someone is in a mild or moderate stage of their disease, then it’s too late.

“Once you have a few examples of someone repeating themselves and not remembering that they did — or not being able to retain recent details — then ask: Do you think we should see a doctor or psychologist?

“I find patients are more ready to use 'the A word' than family members. Patients aren’t stupid, but they don’t want to become a burden. So be honest, and the earlier you have the conversation the better.

“For driving, get medical guidance. Driving can become unsafe in mild to moderate stages of the disease when judgement and reflexes aren’t good. You don’t want to get into an accident and have liability issues. But early on, routine daytime trips to the grocery store or senior center can be fine. Try riding along and assess. When the patient has to turn over their keys, family members should help them remain independent with alternatives like The Ride in Massachusetts, Uber or Lyft."

(Editor's note: Four states require doctors to report patients diagnosed with dementia to their departments of motor vehicles, 14 require that patients self-report, and 32 — including Massachusetts — have no reporting mandate related to driving.)

When a friend or loved one is diagnosed with some form of dementia, how do you recommend talking to them about that news?

“They may want you to understand why their behavior is changing. So start by saying, ‘Thank you for telling me. I want to be as understanding as I can be.’ You don’t need to mention what you have or haven’t noticed about their memory issues. Be sure to stop joking about their symptoms, no more ‘there you go again.’

“You may need to change your behavior and become more patient, which is difficult. We often interrupt people who are repeating themselves and point that out. Dementia patients get offended because while they may not remember events or conversations, they have a very strong emotional memory. They will remember that you are impatient with them and become anxious about your relationship.

“So try to stay calm and show compassion. Don't try to correct the memory problem. Let them have some independence.”

What changes should we be prepared for as the disease progresses?

“You may notice grooming and mood changes. Some patients in mild to moderate stages of dementia withdraw because they can’t follow conversations. In Boston, we like to interrupt each other and talk fast, but that’s over their heads.

My husband was always gregarious, the first one with a joke, but he doesn’t do that anymore because he doesn’t remember the joke. Personalities change. His changes, while progressive, have been slow. He continues to play scrabble and cribbage at the senior center. He is able to drive short distances safely and is not getting lost. However, he often does not remember events that have happened in our lives. And, like many patients with memory loss, he gets frustrated and anxious when he cannot do things.