How Serious Is Memory Loss?

Thursday, December 01, 2005

With recent research on memory loss, as well as the development of medications for Alzheimer’s Disease, more people are seeking their doctor’s advice regarding memory problems.

As a neurologist, I see several patients each day who are concerned about their memory. The internet and media provide much information that can be challenging to sort through. Today, with people living longer, more cases of Alzheimer’s Disease are diagnosed. Here are some common questions I experience in my practice:

Isn’t a certain degree of memory loss normal?

While it is true that one’s memory is never quite what it used to be, anything beyond mild forgetfulness may indeed be abnormal. People tend to minimize their memory issues as “just getting older” or rationalize it by saying “I’m not as forgetful as my friends." Still, as we study memory more, it is apparent that what was trivialized in the past as normal aging may indeed be significant.

Now we recognize a grey area of “minimal cognitive impairment” (MCI) where people note memory worsening but they test well in basic office examinations. Many people with MCI have mild symptoms however, approximately 15 percent every year will progress to Alzheimer’s Disease. Studies are still underway to find the best way to treat MCI. At times, simply following such patients is appropriate while other times the medications used for Alzheimer’s are started. It is best to follow even mild memory loss under a physician’s care to monitor for change.

What is dementia and how is it different from Alzheimer’s Disease?

Dementia is any condition that affects memory abnormally so that it significantly interferes with one’s social function, job or activities of daily living. It is a broad term that can be caused by any number of conditions, one of which is Alzheimer’s. Alzheimer’s Disease is a very specific condition involving progressive degeneration of nerve cells in the brain that not only leads to memory problems, but also causes difficulties in word finding, language, tasks, and judgment.

How do physicians evaluate memory loss?

Evaluation for memory problems begins with a good history investigating the extent of forgetfulness, what type of memory is affected, and whether any other problems such as language issues or poor decision making is present. A review of a patient’s medications is needed as several medicines can cause mental slowing. Also, mood problems should be looked for, as depression and stress can affect memory significantly.

After a history and physical is performed, if the memory loss is indeed significant, the patient may be sent for laboratory and radiological testing. Metabolic and hormonal conditions such as diabetes, thyroid disease and B12 deficiency can be evaluated by blood tests. These are important as they can lead to some diagnoses that are treatable. Structural problems of the brain such as strokes, tumors, and hydrocephalus (a swelling of the sacs of spinal fluid in the brain) can be shown on CT scans and MRI’s. Often such tests are negative in conditions such as Alzheimer’s, because the problem is degenerative and changes occur on a microscopic level. Still, testing needs to be done to rule out other causes of dementia.

Is there a test I can get for Alzheimer’s?

Testing for Alzheimer’s disease can be quite frustrating, because, despite the fact that it is the most common cause of progressive memory problems, there is no specific test for Alzheimer’s. Pathological diagnosis is conclusive, but tests such as brain biopsy are too invasive and typically won’t change disease management. CT Scans and MRI’s of the brain can show brain shrinkage and hardening of the arteries but do not show specific changes for Alzheimer’s. PET Scans, a test measuring the metabolism of the brain, can be very helpful at showing changes of Alzheimer’s but can miss mild cases. Furthermore, PET Scans are expensive and not covered by all insurances. Still, PET Scans, which are only necessary in a minority of patients with dementia, can help in early or questionable cases.

Are there any treatments for Alzheimer’s Disease?

Currently, for all that we know about Alzheimer’s, there remains no cure. However, there are some very good medications that can boost certain low chemicals in the brain that can compensate for the nerve loss occurring. Although this does not reverse dementia, it can stabilize memory loss for a period and decrease the rate of decline. Currently, there are four medications out for Alzheimer’s; many have similar effects and your doctor can discuss which medication is best for you. Many patients ask me about vitamins and supplements.

Many of these have not been adequately studied. The herbal Gingko biloba has been shown to have mild benefits, but not to the degree the available medications provide. Vitamin E, once felt to be helpful as an antioxidant in dementia, probably is not as helpful as it was once thought. On the other hand, high doses of folic acid may have a preventative effect because of folate’s effect on lowering the metabolite homocysteine. Although a safe adjunct to prescription medications, more studies need to be done to fully determine its benefits. Always advise your physician if you are taking any supplements.

In addition to disease-specific medications, one must take into account other issues with Alzheimer’s disease. Keeping the mind active with hobbies such as reading, puzzles, and games not only stimulates the brain but also provides physicians with other ways to track a person’s level of cognitive functioning. Depression often coexists with dementia and can worsen memory. This should be monitored for, not only as it is so common in Alzheimer’s but also because it can be so easily treated.

Later in the disease, anxiety, restlessness, sleep dysfunction, and even agitation and hallucinations can complicate management and make it difficult for caregivers to cope with the disease. A number of medications and treatment strategies exist for these problems, and a neurologist or psychiatrist that specializes in dementia can be very helpful in managing these issues.

At what point should a person with Alzheimer’s stop driving?

Driving is such an essential part of our life that giving it up represents a major change. Although the decision to stop driving is a difficult one, it is an issue that is often dealt with too late by patients and their families. Many people with minimal cognitive impairment and even mild Alzheimer’s have not lost their abilities to manage an automobile. However, as the disease progresses, not only does memory loss make navigation difficult, but patients lose the ability to operate an automobile safely.

Major crossroads in Alzheimer’s are when the abilities to drive, live alone, and handle one’s finances start to fail. Often the person with the disease will deny or, because of the dementia, not realize a problem exists.

When the time comes for a major life decision, caregivers and family members often tell me they hate to be the “bad guy”, but the alternative results in a delay that could be harmful to the patient or to others. Although it is difficult, if caregivers confront these issues earlier rather than later, restriction of activities such as driving can be accomplished in a manner smoother than expected. Families can find help from local branches of Alzheimer’s services and books such as Mace and Rabins “The 36 Hour Day”.

If there are concerns, patients and caregivers should always feel free to discuss them with their physicians.

Gerard J. Dynes, MDDr. Gerard Dynes
Specializing in Neurology