Doctor In Your House: May I remind you about your memory?
BY EVAN L. LIPKIS, MD Special Columnist
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Are you experiencing a change in your memory? Don’t worry too much; most of the time, it is benign and simply a matter of aging. In fact, most people with serious memory problems do not have the capacity to realize that a problem exists. In other words, the patient is not self aware of a memory disturbance. However, frequent memory issues should be evaluated by your doctor and include a thorough patient history and neurological exam. A blood test including thyroid, kidney, liver, B12 and syphilis testing should be completed. An MRI of the brain is often indicated to rule out a stroke, tumor and normal pressure hydrocephalus (Water on the brain which causes memory issues along with balance and urinary incontinence issues). Depression, infection, sleep apnea and certain medicines can also cause reversible memory problems. Alzheimer’s causes 80 percent of dementia or mental decline due to scar tissue or neurofibrillary tangles that form inside the brain cells and amyloidal plaque that forms outside of brain cells.
Alzheimer’s involves memory difficulties, visual-spatial issues, errors in judgment, problems with decision-making, language errors and trouble with attention and concentration. The major problem with Alzheimer’s isn’t memory but rather the troublesome behavior that includes wandering, hallucinations and agitation. Caretakers of demented patients are at higher risk of illness due to the stressful nature of this disease.
Examples of benign memory loss may include:
Forgetting where you put your keys
Searching for casual names and words
Briefly forgetting conversation details
Can’t remember a recipe
Forgetting to sign a check
Cancel a date with friends
Miss an occasional right turn
Examples of Mild Cognitive Impairment (MCI) that often progresses to Alzheimer’s:
May place important items in odd places
Forgetting names of family and friends
May forget entire conversations
Difficulty following recipe directions
Difficulty managing checkbook
Partial or complete withdraw from usual interests
Frequently becoming lost in familiar places
By utilizing the mini mental status exam (MMSE) along with a clock-drawing test, your physician can screen for memory deficits in about five minutes. Advanced neuropsychological testing can be done in cases that are more difficult.
What can be done about memory problems? Thyroid disease, B12 deficiency, infectious problems, kidney disease, liver disease, sleep apnea, excessive alcohol consumption, depression and medication issues must be treated. Medications that may decrease cognitive capacity include narcotics, Tramadol, beta-blockers, muscle relaxants and drugs for urinary incontinence.
No proven treatment exists for benign memory changes and MCI. However, some data supports the following interventions:
1) Keep active and exercise regularly. A New England Journal of Medicine article cited dancing as the most beneficial for memory. A two-decade long Mayo Clinic study showed crossword puzzles, reading and playing a musical instrument were also beneficial. Physical exercise, except for dancing, didn’t do much, but other articles support physical exercise.
2) Consider a Mediterranean Diet. A great deal of scientific literature validated the Mediterranean diet as a central treatment for those concerned with cardiovascular health, cognitive health, and longevity. The brain also consists of 90 percent fat. An abundance of scientific literature concedes that adherence to the Mediterranean diet is associated with better cognitive performance in a variety of cultures. Perhaps the healthy Omega-3 fat is playing a role. In 1,393 individuals participating in a prospective study with follow up of 4.5 years, greater Mediterranean diet adherence was shown to reduce the risk of developing mild cognitive impairment by 28 percent compared to not adhering well to the diet. Additionally, in those who consistently consumed a Mediterranean diet, and did develop mild cognitive impairment, the risk of progressing to Alzheimer’s disease was reduced by 48 percent relative to subjects whose diet deviated from the Mediterranean lifestyle.
3) Stave off dementia by learning Spanish. A new study, published in the Medical Journal of Neurology, found that signs of dementia appeared four years later in bilingual people than people who only speak one language. Scientists believe part of the reason is that learning another language increases the brain’s cognitive reserve. Cognitive reserve is a term used to refer to the brain’s ability to function properly despite damage such as the damage seen in dementia patients.
4) Caloric restriction may improve memory by increasing a brain-derived neurotrophic factor that stimulates brain cell growth.
5) Two recent studies may have allayed concerns about cognitive decline being a possible adverse effect of statin drugs. Both studies suggest that statin drugs may instead be linked to lower rates of dementia in older people. The first study of 58,000 patients showed a dose-related inverse relationship between statin use and new-onset nonvascular mental decline. The second report, in 5,221 patients with atrial fibrillation, found a lower incidence of dementia in patients taking statin medications compared with those not taking statins.
Doctor’s Summary: Memory loss is very common in middle age and in the elderly. Most memory impairment is benign but reversible causes should be evaluated by a physician if memory problems progress. Simple interventions can help slow progression.
Evan Lipkis, MD, is a physician, author and lecturer based in Glenview, Illinois. The advice contained in this column is for informational purposes only. Readers should consult with their physician to evaluate any illness or medical condition. Contact Dr. Lipkis through his website at www.drlipkis.com.