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Do You Remember That You're Forgetting?

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As a specialist in geriatric medicine, I often tell my patients, “If you remember that you’re forgetting, then your memory is probably ok!” While this may not be entirely true, it is pretty close. Many people of all ages will forget names, or forget what they went to get out of the refrigerator. This may get a little worse with aging, but it is not serious. There is a big difference between what we call “age-associated memory impairment,” and the development of a progressive dementing illness such as Alzheimer’s disease.  So how do you know what’s going on?

At IPC-Senior Care of Colorado we might start by performing the Folstein Mini-Mental State Examination. It takes about 10 minutes to perform and will screen you for any obvious mental status impairment. A high score doesn’t assure completely that you don’t have a problem, but makes it highly unlikely. The normal aging process does not lead to significant memory loss. There may be some slowing down of the brain’s processes with age, but not to a significant extent. If there is any evidence of significant changes in mental function, we will perform further mental status testing.

So, what is dementia?  Dementia is when there is a distinct decline in mental function over the course of time. There are five key areas that physicians evaluate to assess dementia.

  1. The first is memory. In Alzheimer’s disease, there is a loss of short term memory. The way we test for this is to give a person three words to remember and ask them to recall those words three to five minutes later.
  2. The second area of mental status that we test in evaluating people for dementia is language function. This is tested by asking a person to name a number of objects. In the early stages of Alzheimer’s disease, language function is relatively kept intact.
  3. The third area is visual-spatial skills. One of the main tests used to assess this today is asking a person to draw a clock. 
  4. The fourth area tested is cognition (the ability to do calculations, abstract thinking, and judgment). 
  5. The fifth and final area that is evaluated is personality.

Dementia is defined by deficits in three out of the aforementioned five areas of mental function. It also must be a deficit that is persistent over the course of time. This differs from short-term changes in mental status that may occur during an acute illness or hospitalization. This used to be called delirium, and is now known as an acute confusional state. This can occur for a variety of reasons, sometimes as a side effect of medications, other times as a consequence of an acute illness.

If a diagnosis of dementia is made, we take a comprehensive approach to its evaluation and management. This begins with a complete history and physical and any pertinent laboratory work and brain scans that are necessary to define the type of dementia and rule out any treatable causes. In the past few years, medications have become available for the treatment of certain forms of dementia, including Alzheimer’s disease and dementia caused by multiple small strokes. While these medications do not provide a cure, they can improve patients function and quality of life for a defined period of time, as well as slow down the progression of the disease. So, remember, don’t be afraid to ask, “How’s my memory?”

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