By David McCormack, Grace Cottage Family Health FNP
How can you tell the difference between the normal memory lapses and memory loss that is caused by Alzheimer’s disease or another form of dementia?
I’m a primary care provider at Grace Cottage Family Health, and lately, I’ve been seeing a number of patients who are concerned about their memory. June is Alzheimer’s & Brain Awareness Month, so I’d like to offer some information about this topic that may help.
People with memory issues may self-report their concern during a medical appointment, or it may be reported by a concerned family member.
The first thing to know is that memory issues may have a wide variety of causes.
For example, memory loss may be caused by sleep apnea, depression, thyroid disease, vitamin deficiency, or excessive alcohol consumption, or it may be a side effect of medications. The starting point for any discussion of memory loss is to do a thorough exam, including a review of diet, nutrition, medications, and sleep practices, and to do lab work to see if any of these point to the cause. It is good to know that many of these conditions often respond well to treatment.
After these issues have been ruled out, the provider will begin looking for another cause.
It will be helpful to conduct a neurological exam, testing a patient’s reflexes, physical coordination, eye movement, speech, and sense of touch, assessing whether the patient has been affected by another condition that can impact memory, including a stroke, fluid on the brain, head trauma, a brain tumor, or Parkinson’s. This exam could also include an MRI or a CT scan.
Beyond this, if these are also ruled out, there are several tests we can use to gauge cognitive impairment.
One of these is called the Montreal Cognitive Assessment (MoCA). This is a 30-question test that takes around 10-12 minutes to complete. The test was published in 2005 by a group of medical professionals at McGill University in Montreal. The questions cover a range of cognitive abilities, from orientation (do you know the day of the week, date, and where you are?), short-term memory (you are given five words, asked to repeat them immediately, and asked to repeat them again a few minutes later), picture and word matching, language, spatial ability, and more. The results of this test can help the provider determine whether there is impairment that needs further study. It can also help the provider determine the most appropriate treatment.
It is important that memory tests occur in the context of a medical visit, ideally with a provider who knows you well. These days, there are home tests on the market, but they have not been scientifically proven to be accurate; they can produce false positives for dementia, causing undue alarm.
Because of this, the Alzheimer’s Association states that, “Home screening tests cannot and should not be used as a substitute for a thorough examination by a skilled doctor. The whole process of assessment and diagnosis should be carried out within the context of an ongoing relationship with a responsible and qualified health care professional.”
Beyond the question of accuracy, it’s important that a patient be assessed by a medical provider who will continue to follow the case, offering ongoing treatment and support. There are medications that can be helpful in preventing rapid progression of Alzheimer’s disease, and your primary care provider will be able to assess any reaction to these medications within the context of other prescriptions and of chronic or emerging health issues. Your primary care provider may also refer you to a neurologist who specializes in memory care for ongoing support and treatment. In our region, we often refer to Dartmouth Health’s Memory Clinic. Occupational therapy may also be helpful.
The Alzheimer’s Association has set aside June as Alzheimer’s & Brain Awareness Month, and it marks June 21, next Tuesday (the longest day of the year) as a special day to raise awareness as the organization continues its ongoing efforts to find a cure for Alzheimer’s.
For now, it’s important to remember that you are not alone. You can get answers and support if you are concerned about memory loss—yours or a loved one’s. If you need help, speak to your primary care provider. I’m also here, if you need me.
