Changes in thinking & memory are not always a sign of dementia.
6 common addressable causes of memory problems you should rule out first.
Noticing changes in our memory or thinking can be scary. Many assume that forgetfulness or trouble concentrating means they are developing Alzheimer's disease or another form of dementia. This fear often prevents people from seeking evaluation — not realizing that many cognitive changes have causes that are potentially reversible.
Identifying the true cause of your symptoms is the first step toward effective treatment and potentially reversing cognitive changes.
Signs & symptoms
"Senior moments," like forgetting a name or misplacing keys, can be unnerving. Some tasks take longer to do than they did 25 years ago, and for most of us, it takes longer to learn new things. Perhaps it's slower, but most of us can still get where we need to be in the end.
These changes are normal. Though sometimes annoying, they do not mean the brain is sick.
When should I worry?
The following are warning signs that thinking has begun to change in ways beyond what is normal:
- Repetitive questioning. Asking someone the same question multiple times in a day or even in a single conversation can be a warning sign of cognitive decline. Telling the same person the same story over and over again is similar.
- Attention lapses. New struggles to follow the plot of a television program or a novel may herald change. Sometimes, people become less aware of changes in the world around them, like current affairs or impending weather events.
- Getting lost, especially in familiar areas. The hippocampus, the part of the brain that helps us remember things, is also involved in supporting our navigational abilities, meaning that getting lost can be a warning sign.
- Mood changes. Sometimes, impending impairment reveals itself via mood changes. Some people develop depression and others anxiety. Irritability can also indicate that changes are occurring.
Addressable causes
Medication side effects
Many medications can affect your thinking and memory, especially in adults over 65. These cognitive effects are often overlooked but can significantly impact daily function.
Several medication classes are known to affect cognition:
- Anticholinergics: These drugs block acetylcholine, a chemical essential for memory and learning. Many common medications have anticholinergic properties, including certain antihistamines (like Benadryl), bladder control medications, some antidepressants, and most over-the-counter sleep aids.
- Benzodiazepines and sleep aids: Medications like Xanax, Ativan, Ambien, and similar drugs can impair memory formation and cause confusion, especially with long-term use.
- Certain pain medications: Opioids and some other pain relievers can affect concentration and clarity of thought.
- Some heart and blood pressure medications: Beta-blockers and certain other cardiovascular drugs may cause cognitive effects in some people.
What you can do: Create a complete list of all medications you take—including prescriptions, over-the-counter drugs, and supplements—and review it with your doctor or pharmacist. Ask specifically: "Could any of these be affecting my memory or thinking?"
Sleep disorders
Poor sleep doesn't just make you tired—it can significantly impair your cognitive function, affecting memory, attention, and decision-making.
Common sleep disorders that impact cognition include:
- Sleep apnea: This condition, where breathing repeatedly stops and starts during sleep, prevents restorative sleep and reduces oxygen flow to the brain. Studies show it can cause symptoms that mimic dementia. Sleep apnea can be sneaky: many people are unaware that they have it. Having a low threshold to seek care is important.
- Insomnia: Chronic difficulty falling or staying asleep impacts the brain's ability to consolidate memories and clear waste products.
- Restless leg syndrome and periodic limb movement disorder: These conditions fragment sleep and reduce sleep quality.
Your sleep might be affecting your cognition if you:
- wake up feeling unrefreshed despite adequate time in bed,
- have been told you snore loudly or stop breathing during sleep,
- feel excessively sleepy during the day, or have difficulty staying awake during quiet activities.
Sleep studies can diagnose these conditions, and treatments—from CPAP machines for sleep apnea to cognitive behavioral therapy for insomnia—can significantly improve both sleep and cognitive function.
What you can do: If you suspect sleep issues, keep a sleep diary for two weeks recording your sleep patterns and daytime symptoms. Share this with your healthcare practitioner and ask about a referral for sleep evaluation if appropriate.
Vitamin & nutritional deficiencies
Our brains require proper nutrition to function optimally. Several specific nutrient deficiencies can cause cognitive symptoms:
- Vitamin B12 deficiency: This is particularly common in older adults due to decreased absorption. B12 is crucial for nerve function and deficiency can cause confusion, memory problems, and even symptoms that mimic dementia.
- Vitamin D deficiency: Increasingly recognized as important for brain health, vitamin D receptors are found throughout the brain. Low levels have been associated with cognitive impairment.
- Folate deficiency: This B vitamin plays a role in cognitive function, and inadequate levels can contribute to cognitive decline.
- Thiamine deficiency: Most common in people with alcohol use disorder, but can also occur with poor nutrition. Severe deficiency can cause Wernicke-Korsakoff syndrome, which includes significant confusion and memory problems.
Simple blood tests can identify these deficiencies, and supplementation often improves symptoms.
What you can do: Ask your doctor about testing for vitamin levels, particularly B12 and vitamin D, especially if you follow a restricted diet, have had weight loss surgery, take certain medications like metformin.
Pre-existing health conditions
Several medical conditions can significantly affect thinking and memory:
- Thyroid disorders: Both underactive thyroid (hypothyroidism) and overactive thyroid (hyperthyroidism) can cause cognitive symptoms like slowed thinking, poor concentration, memory difficulties, anxiety, or trouble focusing.
- Vascular problems: The brain depends on good blood flow. Conditions that affect circulation can impact cognitive function:
- High blood pressure can damage small blood vessels in the brain
- Diabetes affects brain function through blood sugar fluctuations
- High cholesterol contributes to narrowed arteries
- Smoking damages blood vessels and reduces oxygen to the brain
- Hormonal changes: Fluctuations in hormone levels, including those during menopause, can temporarily affect memory and concentration.
- Infections: Particularly in older adults, infections like urinary tract infections can present primarily with confusion rather than typical symptoms.
What you can do: Work with your healthcare practitioners to optimize management of vascular risk factors and other health conditions. Regular monitoring of blood pressure, blood sugar, and cholesterol is essential, along with following recommended treatments and lifestyle modifications.
Depression & anxiety
Mental health conditions can have profound effects on cognition—so significant that depression-related cognitive impairment is sometimes called "pseudodementia" because it can mimic true dementia.
Depression can cause:
- Difficulty concentrating
- Slowed thinking
- Memory problems
- Reduced mental sharpness
- Trouble making decisions
Anxiety can lead to:
- Racing thoughts that interfere with concentration
- Memory lapses due to divided attention
- Difficulty learning new information when anxious
The relationship between depression and cognitive function is bidirectional—depression can cause cognitive symptoms, and cognitive changes can trigger depression. When depression is effectively treated, cognitive function often improves.
What you can do: If you're experiencing cognitive changes along with persistent sadness, loss of interest in activities, worry, sleep changes, or other mood symptoms, talk to your healthcare provider about screening for depression and anxiety. Do not assume that cognitive symptoms are "just depression," however—a thorough evaluation is still important.
Alcohol & use of other substances
Alcohol and other substances can have both immediate and long-term effects on cognition:
- Alcohol: Even moderate alcohol consumption can affect memory formation. Heavy drinking can cause vitamin deficiencies (particularly thiamine), leading to significant cognitive impairment.
- Recreational drugs: Many substances, including marijuana, can impair short-term memory and cognition.
- Prescription medication misuse: Taking higher doses than prescribed or combining medications with alcohol can impact thinking and memory.
Reducing or eliminating substance use can lead to cognitive improvement, though recovery time varies depending on the substance and duration of use.
What you can do: Be honest with your healthcare provider about alcohol and substance use. If you are concerned about your use, ask about resources for cutting back or quitting. Remember that your doctor's role is to help, not to judge.
What you can do if you are noticing changes
If you are noticing changes in your memory or thinking, start by reviewing whether any of the causes discussed in this article might apply to you. While many cognitive changes stem from treatable conditions, pursuing proper cognitive testing is still important. Early detection makes a significant difference in outcomes, regardless of what is causing your symptoms.
At Sunday Health, we can help you navigate this process. Our comprehensive cognitive assessments are designed to evaluate your specific situation, rule out addressable causes, and determine if something more serious is happening. We work closely with your existing doctors, sharing our findings and coordinating your care plan.
Whether your symptoms are due to medication effects, a nutritional deficiency, or something else entirely, identifying the true cause is the crucial first step toward effective treatment and potentially reversing cognitive changes.
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