Knowing when to worry about memory loss

Experts say regular screening is an important tool to identify serious problems

Telling the difference between normal age-related memory loss and something more serious, like the early onset of Alzheimer's, can be difficult. In a post for the New York Times' "Well" blog, Jane Brody explains how people can monitor their cognitive health as they age.

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Some memory loss is a natural part of aging. For instance, Kirk Daffner, the director of the Center for Brain-Mind Medicine at Brigham and Women’s Hospital, has identified six memory problems that he says patients should not be overly concerned by:

  • Forgetting facts or events over time;
  • Absent-mindedness;
  • Temporary difficult recalling something;
  • Only remembering something partially;
  • Being influenced by the power of suggestion (false memories); and
  • Memory being influenced by mood or bias.

Yet, Brody writes that it can be difficult to tell when normal memory problems—like forgetting where you placed something—become a sign of more serious cognitive decline. Doctors have several tools for gauging the severity of cognitive decline.

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Screening for problems

The most comprehensive is a neuropsychological assessment, which involves a battery of cognitive tests on intelligence and memory. Such testing usually involves visiting a specialist and can take multiple days.

Vikas Kotagal, a researcher from the University of Michigan (UM), say early identification of serious cognitive decline "can help families make plans for care, help with day-to-day tasks, including medication administration, and watch for future problems that can occur."  However, a study by Kotagal published in the journal Neurology found that over half of adults with memory loss never see a doctor about their condition.

There are less intrusive screening tests that may help increase the number of people who catch their memory problems early, Brody writes. The most common is the Mini-Mental-State Exam (MMSE), which only requires eight minutes and can be administered by a family doctor.

But Roy Hamilton, a neurologist at the University of Pennsylvania, warns the MMSE is lacking compared to the slightly longer Montreal Cognitive Assessment. For instance, the MMSE doesn't measure executive function and can be skewed by a person's level of education and language proficiency.

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Sam Gandy, the director of the Mount Sinai Center for Cognitive Health, says testing executive function—which is the ability to plan and organize tasks—is particularly important. "Executive function is typically the first area to suffer if you develop cognitive impairment," he says.

Hamilton explains that the Montreal Cognitive Assessment is also more sensitive than the MMSE and can detect even mild cognitive impairment. The test involves things such as counting backward from 100 by seven and recalling words that start with a certain letter of the alphabet.

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Brody warns that "neither the MMSE nor [the Montreal test] are definitive" and only indicate the need for additional testing (Brody, "Well," New York Times, 5/18).

The takeaway: Telling the difference between normal memory problems and more serious cognitive decline is difficult, but experts say there are several simple tests that can help patients identify when to get additional clinical help.

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