Normal forgetting or something more? Memory changes after 60

Almost everyone over sixty knows the moment: a familiar name that won’t come, a room entered for a reason that has vanished. For many people, each lapse brings a flicker of fear. Is this the beginning of something?

Usually, it isn’t. Some changes in memory and thinking are a normal part of aging. But some changes do deserve a closer look — and when they do, an early evaluation is worth having, because a number of causes are treatable, and because knowing sooner gives you more choices.

What normally changes with age

The aging brain is not simply a declining brain. Research on normal cognitive aging paints a mixed picture.1

• What tends to slow: the speed of processing, the ability to juggle several things at once, and the effort it takes to learn new information or to retrieve a word or a name on demand. The tip-of-the-tongue experience becomes more common.
• What tends to hold steady, or even grow: vocabulary, general knowledge, and well-practiced skills — the accumulated expertise of a lifetime.

In daily life, that might mean taking longer to learn a new phone, or needing a list where you once didn’t. The National Institute on Aging gives exactly these kinds of examples — learning more slowly than when you were younger, or forgetting to pay a bill now and then — as typical of mild, age-related forgetfulness.2

Typical changes, and signs worth checking

The Alzheimer’s Association pairs ten early warning signs with the ordinary changes they are often confused with.3 Some of the most common:

Usually a typical age-related change	Worth discussing with a doctor
Forgetting a name or an appointment, then remembering it later	Memory loss that disrupts daily life — asking the same questions again and again, relying on others for things you used to handle
Making an occasional error with bills	Trouble following a plan or a familiar recipe, or keeping track of monthly bills
Needing help now and then with a new device setting	Difficulty with familiar tasks, such as driving a well-known route
Briefly forgetting the day of the week, then working it out	Losing track of dates, seasons, or the passage of time; confusion about where you are
Sometimes searching for the right word	Stopping mid-conversation with no idea how to continue; calling things by the wrong name
Misplacing things, then retracing your steps to find them	Putting things in unusual places and being unable to retrace steps — sometimes suspecting others of taking them
Making a poor decision once in a while	A pattern of poor judgment about money, grooming, or safety

Changes in mood and personality — new suspicion, anxiety, low mood, or withdrawal from work and social life — can also be early signs, especially when other people notice them before you do.

Mild cognitive impairment: the middle ground

Between normal aging and dementia lies mild cognitive impairment, or MCI: changes in memory or thinking that are noticeable — to you, to the people close to you, and on testing — but that do not stop you from managing most everyday activities on your own. The Alzheimer’s Association estimates that roughly 12% to 18% of people aged 60 and older are living with MCI.4

MCI raises the risk of developing dementia, but it is not a sentence. Some people with MCI go on to develop dementia and others do not; in some, thinking stays stable or even returns to normal — particularly when the cause turns out to be treatable.4

Causes that can be treated

Memory problems are not always caused by a disease of the brain. The National Institute on Aging lists causes that can often be treated, including medication side effects, vitamin B12 deficiency, heavy long-term drinking, and some thyroid, kidney, or liver disorders; stress, anxiety, and depression can also make a person more forgetful.2 Other common contributors:

• Depression and anxiety. Both take a toll on attention and memory. In older adults, depression can look like cognitive decline — and improve with treatment.
• Medications. Some widely used medicines, including certain sleep aids, older antihistamines, and anti-anxiety drugs, can impair memory and thinking in older adults. The American Geriatrics Society’s Beers Criteria list medications that older adults should generally avoid or use with caution.5 Never stop a medication on your own — ask the prescriber for a review.
• Sleep problems, including untreated sleep apnea.
• Hearing and vision loss, which make it harder to take in information in the first place.
• Grief, loneliness, and major life changes, which can strain concentration for months.

Sudden changes are different. Confusion that develops over hours or days — especially with a fever, a new medication, or a recent illness — can signal delirium, which needs prompt medical attention. Sudden trouble speaking, weakness on one side of the body, or a drooping face can signal a stroke: call 911.

What an evaluation looks like

A good place to start is your primary care physician. A first evaluation usually includes a conversation about what has changed and when — often with input from a family member — a review of every medication and supplement, a physical examination, blood tests for treatable causes, and a brief cognitive screening. Depending on the findings, the next step may be a neurologist, a geriatric specialist, or detailed neuropsychological testing. If you have Medicare, the annual wellness visit includes a check for cognitive impairment.

Evaluating early has practical benefits. Treatable causes are found sooner. You gain a baseline to compare against later. And if a progressive condition is diagnosed, you have time to plan, to take part in decisions about your own care, and to consider treatment — some newer treatments for Alzheimer’s disease are approved only for its early stages.

What you can do now

The 2024 report of the Lancet Commission on dementia prevention estimated that about 45% of dementia cases worldwide are linked to 14 risk factors that can, in principle, be changed: less education in early life, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, high blood pressure, obesity, excessive alcohol, social isolation, air pollution, and untreated vision loss.6 The estimate assumes these factors are causal, and it describes populations rather than promising anything to an individual. Still, the message is encouraging, and it is never too late to act on it:

• Treat hearing loss. Get tested, and use hearing aids if they are recommended.
• Know your numbers — blood pressure, cholesterol, and blood sugar — and treat them.
• Move every day, and stay socially connected.
• Treat depression, and protect your sleep.
• Limit alcohol, and protect your head — wear a seat belt, and a helmet when cycling.

If you are worried about a parent

Raising memory concerns with a parent is delicate. Many older adults fear dementia, and in many cultures it still carries stigma. In Chinese, the old everyday word for dementia carried a sense of “foolishness in old age” — one reason Hong Kong and Taiwan have adopted more respectful terms. A few approaches help:

• Choose a calm, private moment, and lead with care rather than alarm.
• Describe specific observations — “you seemed unsure of the way home last week” — rather than conclusions.
• Frame a checkup as general health, because it is: many causes are treatable.
• Offer to come along, and, with your parent’s permission, share what you have noticed with the doctor.
• Don’t quiz or argue. Testing someone’s memory at the dinner table helps no one.

How a psychologist can help

When memory is the concern, a psychologist can assess whether anxiety, depression, sleep, or stress are part of the picture; screen memory and thinking and coordinate with physicians on referrals for full testing; teach practical strategies and routines that support memory day to day; and help people and families adjust to a diagnosis, plan ahead, and look after the caregivers.

Memory and cognitive concerns are a core focus of the private practice of Dr. Flora Ma. Her doctoral training is in gerontology, and at the Palo Alto VA she cared for older Veterans, including Veterans living with dementia. She works with older adults and their families in English, Mandarin, or Cantonese, in coordination with their physicians. You can read how private sessions work or write to the office.