The AARP Bulletin ran an interesting title in April, “Am I losing my mind?” This article is in response to the growing paranoia about memory fed by the news that the rate of Alzheimer’s is rising and that many more die of Alzheimer’s than are reported in official statistics. It’s no wonder that if I have a senior moment, I briefly consider whether I am on the slippery path to dementia.
Dementia is a generic term that refers to more than just memory loss. Dementia is a permanent, irreversible and, in some cases, progressive decline in brain skills that interferes with independent living – hence produces disability. There are a multitude of possible causes of dementia. Among sudden causes are stroke and head injury. Slow onset progressive causes include Alzheimer’s disease, Lewy body disease, and Huntington’s chorea.
You can have brain pathology such as stroke, head injury, or Alzheimer’s disease and not be demented. Dementia is a term that reflects the severe loss of ability to function well in the world. Mild or temporary confusion or befuddlement is not dementia.
There are two steps in assessing memory loss and confusion. A good assessment both considers the possible underlying medical causes and provides a description of cognitive strengths and weaknesses, functional skills. Medical assessment for confusion involves more than just a routine physical. There are several important considerations. The following issues, which may respond to treatment, may either the source of the confusion or may make it worse.
Metabolic disorders. For example diabetes, hypothyroidism, or hyperthyroidism are treatable conditions that often present as confusion. Simple blood tests evaluate these systems and are routinely a part of annual physicals.
Brain pathology. Conditions such as normal pressure hydrocephalus, head inuries, stroke (sometimes “silent”), tumors, or vascular malformations may be the source of the confusion. These conditions are assessed by means of brain imaging studies such as an MRI.
Emotional disorders. Severe depression, grief, posttraumatic stress disorder, or anxiety disorders may add to confusion and need to be evaluated as part of the assessment.
Vitamin deficiencies/excess. For example, deficiencies in vitamin B12 produce pernicious anemia, which can be life threatening if left untreated. A part of the work up for confusion should be an assessment of critical vitamins and nutrition.
Medications (including drugs and alcohol). There are a multitude of drugs and medications that can produce confusion or memory loss but very few that improve memory. Assessment needs to broadly consider current medications and make appropriate adjustments.
Neuropsychological assessment. What are your cognitive strengths and weaknesses? Which memory systems are the problem and which continue to work well? How do you know if treatment is helping and how much? How is reasoning and problem solving working? Neuropsychological assessment helps you, as well as those who live with you, better understand how your brain is working and what practical steps to take in developing a treatment plan.