Sept. 10--As greater awareness grows about Alzheimer's disease, fear of Alzheimer's is second only to cancer, according to a study this summer conducted by the Harvard School of Health.

The concern is real, given that 5.4 million Americans are living with Alzheimer's and one in eight Americans aged 65 and older have the incurable memory disorder.

So, when should you worry that you might have Alzheimer's?

"That's a tough one," said Clinton Wright, scientific director of the McKnight Brain Institute at the University of Miami.

He cites a joke about the husband who goes to the grocery store after he's given the order to buy some milk. He comes home and his wife asks, "Did you get the milk?" If his answer is that he simply forgot to buy the milk, and perhaps purchased other items, then this is probably not a problem. But if his response is, "What milk?" this could be a sign of mild cognitive impairment (MCI).

Not everyone diagnosed with MCI goes on to develop Alzheimer's. However, those who do have MCI issues are at greater risk for developing Alzheimer's.

"Normal aging in people is reaction time, things may slow down, what we call 'senior moments.' You're talking and you forget the name of someone and then it comes to you later. That's a normal type of aging. Maybe you don't calibrate things as quickly, but you do get there," said Dr. Allan Herskowitz, chief of neurology at Baptist Hospital.

"In the last number of years it has really changed to what's considered normal memory loss from getting older and what would be thought of as an early dementia process, like Alzheimer's," said Dr. Elizabeth Crocco, medical director of the University of Miami's Memory Disorder Clinic.

She cites an example. "If somebody had a long conversation with someone and totally forgot they had that conversation, or if a person repeats themselves a lot and there's a repeated pattern that interfered with their life, these are things we worry about."

Symptoms of a more serious case of memory loss include headaches, poor speech syntax, a change in personal grooming habits and, often the earliest sign, a change in one's gait. "These are things we neurologists look for," Herskowitz said. "Those are pathological signs and could be a stroke, a tumor, or lots of things."

Forgetting where you parked the car is often not cause for undue concern. You were probably distracted and simply not paying attention.

"If you look back when you parked the car, you probably had a lot on your mind when you were walking from the car to the elevator. If you didn't pay attention, that's less worrisome. That's a natural inattention," said Wright. "A lot of memory lapses happen to a lot of people. If you're not paying attention to something, you're not going to remember it."

If you are asking the same questions over and over or you get lost while driving a familiar route, these can be warning signs of abnormal memory issues and experts advise a visit to a doctor or specialist.

Once there, patients can expect an in-depth consultation with a neurologist "that requires a lot of time where we sit and talk with people and get a good history before we jump to a test," Herskowitz said.

One test, the Mini Mental Status Exam, is a 30-question test of generally simple questions such as, What's today's date? What season is it? How did you get here today? Basic mathematical calculations are included, such as, How much is seven from 100? Spatial tests call on a person to copy two images as well as write a sentence. Each question is worth one point. "Someone who gets 30/30, chances are it's not a problem while 20/30, that's a problem," Herskowitz said.

These patients would undergo further neurological testing.

"Eight out of 10 leave here reassured they are not suffering from Alzheimer's," Herskowitz said.

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