Memory Loss & Dementia
Dementia involves the development of multiple cognitive deficits including significant impairment of memory and impairment in at least one other area of cognitive functioning. Additionally, these deficits must cause major impairment in social or occupational functioning and represent a significant decline from a person’s previous level of functioning.
Early detection of dementia is important. It allows you to take advantage of treatment options as soon as possible and to make important decisions about the future while your thinking is still clear. However, dementia often goes undetected by the primary care physician until it is fairly well advanced. Medications will not stop the disease but may provide important benefits. For some individuals it may help to improve the symptoms of dementia. For others it may help to slow the progression or symptoms.
A neuropsychological evaluation can help to clarify the diagnosis and rule out treatable conditions like depression, which may look very much like dementia. The neuropsychological evaluation can also help to determine the severity and stage of the disorder. Concerns about driving and other safety issues, decision-making and future planning can also be addressed.
If you or a family member are concerned about memory loss or confusion or if your physician is the first to notice a problem, referral for a more in depth evaluation is recommended.
Cognitive domains measured on the neuropsychological evaluation:
Visual spatial skills
Personality and emotional functioning
Types of dementia include:
Frontal lobe dementias
Lewey body dementia
There are many other causes of dementia. Some are treatable. For example, individuals with Normal Pressure Hydrocephalus may present with symptoms of dementia. Other symptoms include gait disturbance and urinary incontinence. These symptoms are treatable and reversible.
Other Related Diagnosis:
Delirium is a condition that resembles dementia. It involves a disturbance of conscious including reduced ability to sustain attention, and other problems with cognition (e.g. memory, orientation, language). This is generally a transient state. It is commonly seen in elderly individuals following major surgery and referred to as a post-operative delirium. A delirium can also be caused by various medications.
Pseudodementia is actually depression and not dementia at all. As noted above, depression can look very much like dementia and must be carefully evaluated. The neuropsychological evaluation can help to tease out important distinctions between depression and dementia so that help can be provided for this very treatable condition.
Mild Cognitive Impairment (MCI) is a relatively new diagnosis. It involves cognitive deficits that are not severe enough to be considered dementia. However, for individuals with MCI there is a higher risk of developing dementia. For example the conversion rate to dementia is 12-14% per year for individuals with MCI versus 1-2% in cognitively normal older adults. Fortunately for many individuals with MCI it does not develop into dementia.
Normal Aging and the Worried Well
Memory, naming, and word finding difficulties are common and sometimes very distressing to the patient. However, these changes may be a part of normal aging. For example memory at the age of 80 is not expected to be the same as it was when we were much younger, and that is perfectly normal. Likewise, the speed at which we process information and carry out many tasks is expected to be slower. It is often very reassuring to the patient to find out that their memory loss or other problems are normal for their age or that they have only mild cognitive impairment and not dementia.