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Memory Loss—Should I Be Concerned?
by Margaret Winker, MD
You and your family should talk with
your doctor or other health care provider to discuss the many
available treatments before one is started. Many researchers
are studying ways to detect, treat, and prevent Alzheimer's
disease.
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Q. I can't remember
things like I used to. Should I be concerned?
A. Memory
problems become more common as people get older. Still,
most people will never develop serious memory trouble. Some
may face mild difficulty with finding words and remembering
names. Others may have more serious memory problems. They
will not remember conversations. Some will have a hard time
functioning in unfamiliar situations.
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Q. What causes memory
problems?
A. They may
be caused by side effects from medicine, strokes, infections,
depression, or thyroid disease. Much less commonly, memory problems
result from inadequate intake of vitamin B12. Some causes of memory
problems can be treated and memory can be restored.
Q. How will I know
if I have a problem with my memory?
A. Often,
people who are having trouble with their memory don't recognize
it. Many times, loved ones and family caregivers notice it. They
find that family members who once functioned independently now
have a hard time caring for themselves.
Oftentimes, people with memory problems are
unable to care for their homes and for themselves as they once
did. They may forget how to perform tasks that they used to complete
with ease. For example, they may forget to prepare meals or find
it difficult to shower.
It can be very hard to see a loved one suffering
from memory loss and admit that there is a problem. As difficult
as it may be, it should be discussed with the person who is struggling.
Then, it should be brought to the attention of the individual's
health care provider.
Q. What will my doctor
or other health care provider need to know about problems with my
memory?
A. Your doctor
or health care provider will need to learn more about the problem.
When does it happen? Has it been the same, better, or worse, over
time? Your doctor also needs to know:
- if there have been any recent changes in
your home;
- all the medicines that you take, including
non-prescription and herbal or natural remedies;
- if you drink alcohol;
- if there's been a change in your health;
- if you have experienced a fever, chills,
pain, or a change in weight;
- if you are depressed;
- if you have experienced changes in your appetite
or sleep patterns;
- if you have had any falls or black-outs;
or
- if you cannot socialize; or
- if you cannot care for yourself as you have
been able to do in the past.
Q. What will the doctor
the doctor do?
A. Your doctor
or other healthcare provider will talk to you about your memory
problems. He or she will then perform a physical exam and do blood
work. Afterwards, he or she may send you to a health care provider
who specializes in the care of older adults. This field of medicine
is known as geriatrics.
Or, your doctor may want you to go for a screening
test that provide images of the brain, such as a CT (computerized
tomographic) scan or a MRI (magnetic resonance imaging). Sometimes,
these tests are needed to learn about the cause of the problem.
Q. What if I complete
a screening test and the results are normal or borderline?
A. The doctor
or healthcare provider may tell you to keep track of any memory
problems over the next few months. He or she may also ask you
to repeat the screening test in six months. Or, the doctor may
suggest another type of memory testing, called a neuropsychological
test.
Q. What is a neuropsychological
test?
A. This type
of testing is like the memory screening. However, it involves
more questions and tasks. This test can recognize problems that
are not severe enough to appear on the screening test. It also
helps uncover conditions that may contribute to memory loss, such
as dementia or another condition.
If the results are 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 more tests may help find the cause of memory
loss.
Q. My doctor said that
the changes in my memory are due to age and are not cause for concern.
Still, this is difficult. I am more forgetful than I used to be.
What can I do to help remember things?
A. You can
keep a notepad with you where you can write down names or events
that you need to remember. You can also use a neck chain for keys
or glasses. Finally, try to do important daily activities at the
same time each day. Getting into a routine can help you remember
important daily practices.
Q.What if the neuropsychological
test is abnormal?
A. If the
memory test is abnormal, the doctor will talk with the person
and caregiver 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). Less commonly, memory loss can be
caused by thyroid disease. Much less commonly, a low vitamin B12
level or inadequately treated syphilis can cause memory problems.
If no other explanation for the memory loss
is found, the most common cause for memory loss is Alzheimer's
Disease. Currently, the only way to know for certain that a person
has Alzheimer's disease is by taking a small sample of the brain.
This is called a biopsy. Biopsies are 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.
Q. What if my doctor
thinks I have Alzheimer’s disease?
A. If Alzheimer's
Disease is the most likely diagnosis, it can be helpful to learn
about what to expect with Alzheimer's Disease and about the support
services that are available. Right now, there is no cure for Alzheimer's
Disease. One treatment, called acetylcholinesterase inhibitors
(tachrine [Cognex ®], donepezil [Aricept ®], rivastigimine
[Exelon ®]) may help some of the symptoms of memory loss.
However, the drugs have common side effects of nausea and diarrhea.
Tachrine can cause reversible liver damage. These drugs can improve
memory equal to about four to six months of memory decline, but
memory will continue to decline after the drug is started. If
the drug is stopped, the memory loss will become as severe as
if the drug had never been started.
Some other ways of treating Alzheimer's disease
are also being explored. Some research has shown that people those
with mid-stage (or moderate) Alzheimer's disease have been helped
by Vitamin E. Vitamin E has not been shown to improve symptoms.
However, it has helped to delay the onset of more advanced stages
of the disease. Ginkgo biloba, a plant extract, may also help
people affected by Alzheimer's disease. Some improvements in thought,
activities of daily living (such as bathing and dressing) and
social behavior have been noted.
You and your family should talk with your doctor
or other health care provider to discuss these treatments before
one is 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, you can contact a few organizations,
including the Alzheimer's Association or the Alzheimer's Disease
Education and Referral Center at the National Institute on Aging
(ADEAR). You can also speak with your doctor about researchers
in your area. They can also give you more information about different
types of memory loss.
Q. Where can I learn
more about memory loss?
A.
The American Geriatrics Society
The American Geriatrics Society's Complete Guide
to Aging & Health. (Check your local library, or call (800)
677-9944, for a 35% discount through AGS.)
Patient Education Forum, Dementia www.americangeriatrics.org/education/forum/dementia.shtml
Foundation for Health in Aging, established
by The American Geriatrics Society
Alzheimer's Disease Information under "Programs": http://www.healthinaging.org/program.html;
and "Memory Loss" and "Behaviors Associated with
Dementia" in Eldercare at Home: www.healthinaging.org/eldercare.html
Alzheimer's Association
(800) 272-3900
www.alz.org
Alzheimer's Disease Education and Referral
Center
(800) 438-4380
e-mail: adear@alzheimers.org.
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