Alzheimer's Disease - Should I be
Concerned with Memory Loss?
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.
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.
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
