We all forget things. Even in our twenties, we might lose our keys or forget the name of someone we just met. As we age, these moments of forgetfulness happen more often. For people in their late forties and early fifties, the onset of menopause can bring even more brain fog and memory lapses.

But the big question is: when should you worry that something is wrong? Is it just menopause, or might it be early warning signs of Alzheimer’s disease or dementia?

“It’s important to remember that there are lots of causes for brain fog,” says Lynne Shinto, N.D., M.P.H., a naturopath with expertise in neurology and women’s health at the OHSU Center for Women’s Health.

Most of them are far less scary than Alzheimer’s disease. Here are a few of the most common causes:

• Hormone changes during the transition to menopause
• Other hormone changes (for example, thyroid problems)
• Depression
• Stress
• Lack of sleep
• Vitamin and mineral deficiencies (such as vitamin B12)

Many of these causes come in pairs, or even trios. Stress can lead to lack of sleep or depression. The transition to menopause can lead to hot flashes that impact sleep, or to depression. Depression can lead to stress.

Poor thinking ability and memory problems are a very common symptom of depression.

For many people, treating their depression clears up symptoms of brain fog and cloudy thinking. For this reason, everyone with these symptoms, even people in their seventies and beyond, should be screened for depression.

Brain fog and dementia are different

The cloudy thinking you get with brain fog is also very different from cognitive problems associated with dementia or Alzheimer’s disease.

The key difference is that diseases like dementia and Alzheimer's disease affect more than memory. They change your ability to function in your daily life. Dr. Shinto asks patients these questions:

• Have you stopped working and/or taking care of household finances? If so, why?
• Have you stopped doing household tasks you’ve always done?
• Have you stopped doing social activities you used to?

“These functional changes, coupled with memory complaints, may indicate something more than brain fog,” says Dr. Shinto. “If you answer yes to these questions, talk to your primary care provider for further screening.”

Healthy brain aging

Some brain fog or memory loss happens naturally with age.

“I call it healthy brain aging,” Dr. Shinto says. “Maybe you write reminders to yourself. Maybe you forget your glasses or a word every now and then. It happens to all of us as we age.”

As long as it’s not keeping you from functioning day-to-day you don’t need to worry.

“Think about your friends who are your age,” suggests Dr. Shinto. “If you are functioning at about the same level, you probably just have healthy brain aging.” 

Preventing Alzheimer’s disease and dementia

There are things you can do that help decrease your risk of dementia. Prevention is about lifestyle. Eating a healthy diet, physical activity and social engagement make a big difference.

There’s one other important element. Dr. Shinto calls it maintaining an “active brain.”

“People who are still challenging their brains as they age through work, volunteering or learning something new like playing an instrument have a lower risk of dementia,” Dr. Shinto says.

What about brain games?

The evidence is not conclusive. Some studies show some games may help a little and others show they make no difference. Most games are repetitive and may not fully "activate" your brain.

“It’s not that games can’t challenge your brain, but if you play the same games all the time, you figure them out. You can anticipate what comes next and your brain is less engaged,” says Dr. Shinto.

Have concerns?

If you are worried you or a loved one has signs of dementia, take a look at this list of signs from the Alzheimer’s Association There is a brief cognitive screening test that your primary care provider (or Dr. Shinto herself) can do. The results can help ease your mind or set you on the right path to get treatment.