The First Step - When To See A Doctor: Improving Memory Understanding Age Related Memory Loss

Improving Memory Understanding Age Related Memory Loss
Improving Memory: Understanding age-related memory loss
What is memory?
How we remember
Forgetting: What's normal?
How memory changes with age
Mild cognitive impairment
Causes of memory impairment
When to see a doctor
The first step
Neuropsychological testing
Specialized tests
Medications for memory impairment
Improving everyday memory
Preventing memory loss
On the horizon
Glossary
Resources

Content provided by the Faculty of the Harvard Medical School

The first step

Begin with a consultation with your primary care physician. Because this doctor knows you and your medical history, he or she is in a good position to relate your memory symptoms to medications you are taking and medical conditions you have had. But don't necessarily expect to walk out of your doctor's office with a definitive diagnosis. There is no single test that can pinpoint the cause of memory loss. The diagnostic process often requires a physical exam, a variety of tests, and, depending on the results, monitoring over a period of several months or even longer. Expect your doctor to ask you a lot of questions about your memory. For example:

How long have you been having trouble with your memory?
Did the trouble come on gradually or suddenly?
What sorts of things have become hard to remember?
Are your difficulties preventing you from doing ordinary things like cooking or reading?
Are you taking any prescription or over-the-counter medications (other than those prescribed)?

These questions help the doctor narrow down the possible causes of your memory loss. For example, the doctor will need to know whether you are taking any medications that might have a known association with memory impairment. If your memory loss came on suddenly — shortly after taking a drug that is known to affect memory — then the diagnostic process may focus on that drug. Depending on the medication, the doctor may ask you to stop taking it or may prescribe a different drug to see whether your memory improves.

Your answers about the nature of your memory loss also provide important clues. If you're having trouble remembering the names of people you meet and you forgot a doctor's appointment, that suggests that the problems you're experiencing — however troublesome — probably fall in the normal range. But if your memory difficulties are forcing you to cut back on activities you once did regularly, the underlying cause may be something other than normal aging (see "Causes of memory impairment").

Does your memory trouble interfere with ordinary activities?

Because certain emotional and medical conditions can affect memory, the doctor will review your medical history, ask you about new symptoms and illnesses, and perform a physical exam. For example, the doctor will measure your blood pressure and blood sugar to look for hypertension or diabetes. If you have one of these conditions, your doctor can make sure that it is properly controlled, either with medication or through lifestyle adjustments, such as a modified diet. Your doctor may also check your blood and urine for signs of kidney or thyroid problems. The doctor may ask whether you've been under a lot of stress lately or if you've been feeling blue, because stress and depression can cause memory impairment as well as loss of interest in previously enjoyable activities. If depression is an issue, your doctor may refer you to a psychologist or a psychiatrist for further evaluation and treatment.

To reach a clear diagnosis, the doctor may need to track your symptoms for several months and may ask you or your spouse to keep a record of your symptoms and then return to the office after several months. He or she can then determine if the symptoms are improving, staying the same, or getting worse.

Normal aging or dementia: A questionnaire

How do you know when memory loss is an early symptom of Alzheimer's disease or another type of dementia? There's no question that severe, progressive memory loss is a hallmark of dementia, but research suggests that forgetfulness alone is not a perfect predictor of Alzheimer's disease. Researchers at Harvard Medical School found that responses to eight standard clinical questions predicted with a high degree of accuracy whether people with memory impairment would remain stable, decline, or improve. The eight questions were derived from three categories: judgment and problem solving, home and hobbies, and personal care, as follows:

Judgment and problem solving

Do you have increased difficulty handling problems (e.g., are you relying more on others to help solve problems or make plans)?
Is there a change in your pattern of driving that is not the result of vision problems (e.g., a greater degree of caution, trouble in making decisions, etc.)?
Is your judgment less sound than it used to be?
Are you having increased difficulty managing finances (e.g., maintaining a checkbook, paying bills, making complex financial decisions)?
Are you having more difficulty handling emergencies? Have you been making unsafe decisions? Do you rely more on cues from other people in order to react appropriately?

Home and hobbies

Are you having increased difficulty performing household tasks, such as cooking or learning how to use new appliances?
Has there been any change in your ability to pursue your hobbies? For example, do you spend less time on complex hobbies? Do you have more trouble following the rules of games? Do you read less, or do you need to reread more often in order to understand what you've read?

Personal care

Do you need prompting to shave or shower?

Scoring: People in the study who answered yes to all of these questions were most likely to develop Alzheimer's within three years.

The purpose of this quiz is to indicate if you have symptoms that warrant further evaluation. It is not intended to diagnose a memory disorder. If you answered yes to four or more of the above questions, see your physician.

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Last updated:	January 23, 2007

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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