Everyone is afraid of getting Alzheimer’s Disease. So it’s common for some people, especially as they age, to worry if they think they have memory problems. Most are fine.
If a patient comes in for care on their own with the concern, the best reassurance is to explain that people with serious brain conditions aren’t aware of the problem. They don’t remember that they’re forgetting! It’s normal for people of all ages to forget things, especially if under stress.
Basically, we try to distinguish among the following:
- No true memory problems
- Memory problems due to a medical condition
- Mild memory loss (called Mild Cognitive Impairment)
- Dementia (profound memory problems that will get worse, various causes)
For sudden memory loss or confusion (hours or days) → send to E.R. (best by ambulance)
- Called “Delirium,” could be a life-threatening medical condition (click link for long list of possibilities)
Assuming patient has had Gradual Onset Memory Loss
1. We define seriousness of memory loss, best obtained from family / friends:
- Does it interfere with normal activities and job?
- Is it dangerous? (forgets food on stove, loses keys, gets lost, serious financial errors)
- Do they forget things others wouldn’t (like names of major people in their lives)?
- Have they had personality changes during the same time frame?
- Perform 8-Point Memory Questionnaire for family / friends
2. We ask about key events occurring just before memory loss began:
- Head Trauma (needs CT scan brain, for Blood Clots)
- New medications (discontinue / change them if possible) (esp. benzodiazepines for insomnia or anxiety: lorazepam, diazepam, alprazolam, zolpidem, etc.)
- New or increased alcohol / drugs (stop using as best possible)
- Significant symptoms of Depression or Anxiety (these may be the cause)
3. Physical Exam including Neurological Exam for key abnormalities to diagnose certain medical diseases as cause (stroke, tumor, etc.)
4. We perform Cognitive Testing (ability to remember & process information)
- May include: remembering 3 words at 5 minutes; drawing a clock at “10:20”
- Name as many animals as possible in 1 min. (>18 = normal; <12 = Dementia)
- See Full Text for other examples
If Cognitive Testing is Abnormal, or if Description of Memory Loss is Serious
5. Order basic Lab tests (for medical conditions causing memory loss)
- Complete Blood Count (CBC) — may give clues to underlying diseases
- Comprehensive Metabolic Panel (blood) — for kidney function, liver function, & more
- Thyroid Stimulating Hormone (TSH) — for Thyroid Diseases
- Vitamin B12 level for B12 Deficiency (if borderline, order test for Methylmalonic Acid)
- Consider Syphilis tests for late-stage Syphilis, also HIV Test
6. Consider non-contrast CT Scan of brain (for blood clots, other conditions)
A. If medical conditions identified → we Treat them
B. If Dementia (by Cognitive Testing) → Refer to Neurology if desiring specific diagnosis
- Prevent small, subtle strokes that may cause dementia by treating Hypertension, Diabetes, High Cholesterol, & Cigarette addiction
C. If Mild Cognitive Impairment (by Cognitive Testing)
- Consider MRI for prognosis (chance that dementia will develop) [see text]
- Consider referral to Neurology
- Consider following every 6-12 months for progression
D. If Cognitive Testing Normal
- We reassure
- Consider some Lab Tests as in #3 above
- Explore possible diagnosis of Depression or Anxiety
See Memory Loss — Full Text for more in-depth explanations and discussions (including some interesting cases).