Introduction

• Memory loss can be a normal part of aging process.

• As people get older, degenerative changes occur in all parts of the body, including the brain.

• As a result, it may take longer time to acquire and remember new information for some elderly.

• A number of conditions can cause memory loss in older adults.

• Therefore, it is important for the elderly who are experiencing any memory problems to seek help from their doctors for a  timely diagnosis and appropriate management.

Causes of memory problem

A number of conditions can cause memory loss in elderly, it includes:

• Memory problem with aging

• Memory problem associated with degenerative diseases such as Alzheimer’s disease, stroke, Parkinson’s disease and other related disorders

• Memory problems due to reversible conditions

Memory problem with aging

• Normal age-related memory problem does not prevent elderly from living an independent and productive life.

• For example, the elderly may forget a person’s name but able to recall it later or they might misplace their personal belongings occasionally e.g. glasses. Sometimes, they might need to make a list in order to remember tasks or appointments.

• However, these changes in memory are generally manageable and do not disrupt their ability to work, socialize and live independently.

Memory problem associated with Dementia such as Alzheimer’s disease and related disorders

• Dementia includes as a set of cognitive symptoms, including impairment in memory, orientation, language, planning, reasoning, judgment, and other thinking skills.

• Dementia usually begins gradually, progresses and worsens over time and significantly impairs a person’s abilities to work, socialize and disrupt their capability to live independently.

• Often, recent memory loss is one of the first or more recognizable symptoms of dementia.

Memory problems due to reversible conditions

Some medical problems can cause reversible memory loss or other dementia-like symptoms. Most of these conditions can be diagnosed and treated successfully to improve memory outcome. Possible causes of reversible memory loss include:

• Medications side-effects

• Vitamin B-12 deficiency

• Chronic alcoholism

• Head injury

• Brain tumors, infection or blood clots

• Hypothyroidism

• Emotional problem e.g. depression, stress and anxiety

Important to note that sometimes, the reversibility of dementia-like symptoms may not be complete. This may be due to permanent structural brain damage due to the long standing problems. More commonly, there may be a concurrent dementia like Alzheimer’s disease.

Diagnosis

Getting a prompt diagnosis is important but sometime it is challenging. Identifying a treatable cause of memory problem enables the patient to get appropriate treatment. Therefore, elderly with memory problems should see a doctor for further evaluation. A correct diagnosis depends on accurate information, so in addition to talking with the patient, the doctor might ask a family member, caregiver or friend for further information.

A complete medical evaluation for memory loss should include:

• Detailed medical history, including the use of prescription and over-the-counter medicines, dietary history, past medical history and general well-being

• A thorough physical and mental health assessment

• Formal cognitive tests for memory, orientation, attention, problem-solving and language abilities

• Blood tests e.g. serum vitamin B12 level, thyroid function test

• A computed tomography (CT) or magnetic resonance imaging (MRI) brain scan may help to rule out some causes of the memory problems

Treatment

• The treatment will depend on the cause of memory loss

• For elderly patient with memory problem due to Alzheimer’s disease, various drugs are available to control the symptoms of Alzheimer’s disease

• Memory problems due to the reversible conditions may improve and sometime cured,  by treating the underlying causes e.g. treating hypothyroidism with thyroid hormone replacement is the most effective way to reverse the memory problem

Elderly with some memory problem can use a variety of techniques to help them to maintain their memory and mental skills. Some helpful tips include:

• Compensatory techniques such as using a ‘to do list’ will help as a reminder to assure tasks are not forgotten

• Establishing day-to-day routines will make sure that everyday tasks can be remembered easier

• Putting things at its usual place will help to avoid confusion

• Associating names or objects to a more familiar information helps to recall things easier

• Keeping a calendar to display important dates will make remembering dates much easier

Prevention

Various actions have been suggested to prevent memory loss. The Mayo Clinic has suggested seven steps to prevent memory problem and to improve memory i.e.

• Stay mentally active – mentally stimulating activities help to keep the brain active and prevent memory loss

• Socialize regularly – social interaction can help to prevent depression and stress which might lead to memory loss

• Get organized – keep to-do lists, set aside a certain place for the wallet, keys and other essentials

• Focus on the task, limit distractions and do not try to do too many things at one go

• Eat a healthy diet – a heart-healthy diet is also as good for the brain

• Include physical activity in daily routine – physical activity can  increase blood flow to the whole body, including the brain

• Manage chronic conditions such as diabetes, high blood pressure and depression appropriately as recommended by doctor

Screening

Genetic screening such as APOE gene which may be advocated by some parties should not be done as a routine screening test.

References

1. Forgetfulness: Knowing when to ask for help. National Institute on Aging.http://www.nia.nih.gov/HealthInformation/Publications/forgetfulness.htm. Accessed Jul 10, 2013.

2. Nilsson LG. Memory function in normal aging. Acta Neurol. Scand. Suppl. 2003;179: 7–13

3. Mayo Clinic Staff. Memory loss: 7 tips to improve your memory. Mayo Clinic. Retrieved Jul 10, 2013

4. Mayeux R. Clinical practice: Early Alzheimer’s disease. New England Journal of Medicine 2010;362:2194.