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by Margaret Winker, MD
"Problems with memory can have many
causes. If you have trouble with your memory, you should discuss
the problem with your doctor."
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Q. I can't remember
things like I used to. Should I be concerned?
A. Although
problems with memory become increasingly common as people
age, most people will never develop significant memory impairment.
Some people may experience mild problems with word finding
and remembering names; others will develop more substantial
memory problems with inability to remember conversations or
difficulty functioning in unfamiliar circumstances.
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Q. What causes memory
problems?
A. Some mild
memory problems can occur in normal older adults, but sometimes
memory problems can be a sign of temporary confusion, called delirium,
or more persistent memory loss, called dementia. It is difficult
to predict whether a person who has mild problems with memory
will go on to develop more severe memory loss, because dementia
becomes more common as people age. Problems with memory can have
many causes, including medication side effects, strokes, infections,
depression, thyroid disease and vitamin B12 deficiency, so it
is important to be aware of problems with memory and identify
causes that can be treated or prevented. Often caregivers are
the first to notice that a family member is having problems with
memory.
Q. Should I see a doctor
if I have trouble with my memory?
A. If you
have trouble with your memory, you should discuss the problem
with your doctor. Tell the doctor the specific problems, when
they occur, any recent changes in your home environment, and all
the medicines you are taking, including nonprescription and herbal
or "natural" remedies; also let him or her know if you
drink alcohol. Tell your doctor about when the problems first
started, and whether the problems have been the same, worse, or
better over time. Any fever, chills, pain, weight loss or gain,
or recent changes in other medical conditions should be discussed
with your doctor. Any problems with depressed mood should be discussed,
including problems with appetite or sleep disturbance. Be sure
to tell your doctor if you have had any falls or blackout spells
or if you are no longer able to care for yourself or socialize
or do errands like you have in the past.
Q. What will the doctor
do?
A. After discussing
these issues and performing a physical examination, your doctor
may perform a screening memory test that includes basic questions
regarding memory. The result of the screening test may be normal,
borderline, or abnormal.
Q. What if I complete
a screening test and the results are normal or borderline?
A. If the
memory test is normal or low-normal, the doctor may suggest that
you keep track of any memory problems over the next few months
and repeat the test after six months or so. Or the doctor may
suggest another type of memory testing called neuropsychological
testing. This type of testing is similar to the memory screen
but includes many more questions and tasks. The purpose of this
test is to find out if the problems with memory are not severe
enough to show up on the screening test, but are apparent in the
more in-depth test. If the neuropsychological testing is normal,
then the problems with memory are likely the very mild memory
problems that may occur with aging. If the test is borderline,
the results can help the doctor decide if additional testing might
be important to look for a cause of memory loss.
Q. What if the test
is abnormal?
A. If the
memory test is abnormal, the doctor will talk with the person
and caregiver, if involved, about evaluating possible causes of
memory loss. Longer-term memory loss may be caused by a number
of conditions including Alzheimer's Disease and vascular disease
in the brain (small strokes in the brain), and less commonly,
by thyroid disease, a low vitamin B12 level, or inadequately treated
syphilis. In addition to the history of the memory problems and
the physical examination, blood tests, and sometimes imaging studies
of the brain, such as CT (computerized tomographic) or MRI (magnetic
resonance imaging) are necessary to detect most of these illnesses.
If no other explanation for the memory loss
is found, the most common cause for memory loss is Alzheimer's
Disease. With the tests currently available, the only way to know
for certain that a person has Alzheimer's Disease is by taking
a small sample of the brain, called a biopsy. This test is very
rarely done, so Alzheimer's Disease can only be presumed in most
people. Researchers are trying to develop new tests to diagnose
Alzheimer's Disease, but so far no tests are reliable enough to
use for diagnosis.
Q. What if I have probable
Alzheimer's Disease?
A. If Alzheimer's
Disease is the most likely diagnosis, you and your family members
may benefit from information provided by organizations about what
to expect with Alzheimer's Disease and about the support services
that are available. No treatments that we know of will cure Alzheimer's
Disease. One treatment may help some of the symptoms of memory
loss, but the drugs, called acetylcholinesterase inhibitors (tacrine
[Cognex], donepezil, [Aricept]) have common side effects of nausea
and diarrhea, and one drug, tacrine can cause reversible liver
damage. These drugs can improve memory equal to about four to
six months of memory decline, but memory will nonetheless continue
to decline after the drug is started, and if the drug is stopped,
the memory loss will become as severe as if the drug had never
been started.
Many researchers are studying ways to detect,
treat and prevent Alzheimer's Disease. If you would like to participate
in a study of Alzheimer's Disease, or would like more information,
you can contact the Alzheimer's Association, the Alzheimer's Disease
Education and Referral Center at the National Institute on Aging,
or speak with your doctor about researchers in your area.
For additional information:
For information regarding dementia or delirium,
you can ask your doctor, or refer to The American Geriatrics Society's
Complete Guide to Aging & Health. (To obtain a copy, check your
local library, or call 800-677-9944, for a 35% discount through
the AGS.)
The Alzheimer's Association can be reached at
800-272-3900, or, if you have access to the Internet, contact them
on the World Wide Web at http://www.alz.org
Alzheimer's disease Education and Referral Center
can be contacted at 800-438-4380; or by email at: adear@alzheimers.org
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