Normal Versus Abnormal Forgetting

Tests of memory and related cognitive functions can help distinguish memory disorders from normal, age-related memory loss. And make no mistake: age-related memory loss is not a disorder. However, two memory disorders—mild cognitive impairment and dementia—do become more common with age, leading memory researchers to wonder if there is any relationship between them and age-related memory loss.

Experts disagree about the answer. Some say that mild cognitive impairment and dementia are entirely distinct from age-related memory loss. We refer to this view as the discontinuity model. In this view, age-related memory loss is an effect of the normal developmental evolution of the brain in the same way as 118 diminished bone density is the normal and inevitable destiny of the aging human skeleton. On the other hand, discontinuity adherents view dementia as the product of a pathophysiological disease process, a divergence from normal health and development.

Other experts view age-related memory loss, mild cognitive impairment, and dementia as points on a single continuum extending from normal to abnormal memory. This is not to say that age-related memory loss will inevitably lead to mild cognitive impairment and then to dementia. How far an individual progresses along this continuum depends on a number of factors, many of which have been reviewed in earlier chapters. However, supporters of the "continuity hypothesis" believe that the patho-physiological process that underlies age-related memory compromise is essentially the same across all points. The implication of this view is that each and every one of us would ultimately arrive at a state of dementia if we lived long enough.

We won't know which model is more accurate until we learn more precisely what happens in the brain with age-related memory loss, mild cognitive impairment, and dementia. But we do know that there are several ways to reduce or reverse age-related memory problems, whereas at this point we do not have actual disease-modifying therapy for mild cognitive impairment or dementia.

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