I forget words. I forget appointments. I forget people’s names, too. Am I coming down with Alzheimer’s? 

Questions like this probably came to many of the 130 people who attended forum last month at the Unitarian Society of Germantown. “Fear of Forgetting,” sponsored by Weavers Way, Northwest Village Network, Ralston My Way and the Unitarian Society, was the second in a series devoted to health issues of the elderly. A forum in November 2015 dealt with quality-of-life issues and end-of-life choices as discussed in Atul Gawande’s book “Being Mortal.”

Issues relating to dementia among the elderly are the main concerns of the Penn Memory Center, whose co-director, Dr. Jason Karlawish, was the first presenter at the May 1 forum. 

Since the first description by German psychiatrist Alois Alzheimer in 1907 of “an unusual disease of the cerebral cortex,” the disease has made its way into daily conversation and has come to be especially dreaded as a sort of death of personhood. It has proven to be quite unresponsive to drug treatment. However, Karlawisch predicted that by 2025 we will have ways to better define the underlying causes of Alzheimer’s disease and thereby come closer to effective treatment. 

The current treatment model focuses on early intervention, before the disease’s more obvious manifestations. One approach is a study in which Penn is participating: accumulating brain scans of “normal” people, looking especially for high levels of amyloid plaques in the brain. Amyloid plaques are sticky buildups that accumulate outside nerve cells, or neurons. Amyloid is a protein that is normally found throughout the body. But in Alzheimer’s disease, the protein divides improperly, creating beta amyloid, which is toxic to neurons in the brain. Much as was done for heart disease in the famous Framingham study, researchers watch these volunteers over time to detect plaque accumulations. (Volunteers are welcome to participate in this “A4 Study”; visit www.a4study.org for information.)

Since the 1970s, evidence has been accumulating that the risk of developing dementia is declining, although with an increasing population we still have many cases. Why it is declining is not known. One possibility has been the increasing effectiveness of treatments for cardiovascular disease. It should be noted, however, that the risk level has not diminished for those with less than a high school education and for those in poverty.

The other two forum participants, Felicia Greenfield, clinical director of care programs at the Penn Memory Center, and Frederica Waugh, of the Delaware Valley Alzheimer’s Association, emphasized care for both patients and caregivers. The Penn Memory Center has a monthly support group for caregivers, while the Alzheimer’s Association deals with both caregivers and people suffering from Alzheimer’s. Since patients may live with dementia for several years, the stress on loved ones and caregivers can be profound.

So, does forgetting words, names and appointments mean that you coming down with Alzheimer’s? Not necessarily. These effects often are part of the normal aging process. Doctors call it “mild cognitive impairment” or MCI. However, MCI is currently used very loosely, and probably much too frequently, Karlawish said. It’s cognitive aging — a common experience for people 60 and over. 

But when symptoms seem to go beyond “mild,” a diagnosis by a qualified medical team is the next step. Qualification in this case could involve physicians who are geriatricians, neurologists or psychiatrists, but in addition they should be well versed in Alzheimer’s issues and treatment. Currently there is a shortage of up-to-date Alzheimer’s tools and expertise.

Is there an ounce of prevention that might work? There are many factors that are said to help, and the decline of dementia in developed nations is probably attributable to improvements in cardiovascular health, to exercise, to social and occupational engagement, to improvements in diet and to factors unknown.

In sum, there is a lot of hope for improvement in diagnosis, but less so for cures. Research may well show that the term Alzheimer’s actually embraces a number of disparate causes. Organizations like the Penn Memory Center and the Alzheimer’s Association seek to provide increasing support for the families and caregivers. 

The sponsoring organizations — Weavers Way, Northwest Village Network, Ralston My Way and the Unitarian Society — plan to continue this forum series in the fall, with an exploration of the costs of caring for the elderly.