Frequently, my patients will come to a visit and bring up a major concern: “Doc, I think I might have dementia; my memory seems to be slipping.” They might give examples of having difficulty finding words, forgetting people’s names, or just feeling like their thinking is slower. Many of them know a family member who had dementia, and they are worried.
My first response is to hear their concerns; of course, if a patient is showing early signs of dementia, we want to assess that and do our best to get to a diagnosis for them. What I have found, however, is that often when these concerns are raised, we find things that are not dementia to explain them.
As we age, some symptoms perceived as memory changes are probably within the spectrum of normal. The occasional forgetting or having a delay finding words is a great example of this. More difficulty recalling names is another. This can be normal at any age but tends to happen more frequently as our brains age.
Sometimes patients are noticing real and concerning issues, but through medical evaluation, we find non-dementia reasons for them. The most common reason would be – you guessed it – medications. While many medications can affect cognition especially in older patients, often we can blame drugs with anti-cholinergic properties (even over-the-counter diphenhydramine found in cold, allergy, and sleep medication) and benzodiazepines (usually prescribed for anxiety or sleep). Patients should review their medications, both prescription and over-the-counter, as an early step in evaluating these concerns.
Other common mimics of cognitive change in older patients are depression, anxiety, and sleep disorders. These disorders can cause the brain to be unfocused and distracted which frequently manifests as forgetfulness. Treating the underlying condition effectively will usually improve one’s cognition, so we should look for signs of those when evaluating memory concerns.
Numerous other medical causes can also impair one’s cognition and memory. These include vitamin deficiencies, abnormal electrolytes, infections, or abnormalities in the brain like bleeding, tumors, or hydrocephalus. Further, there are numerous causes of dementia; Alzheimer’s disease being just one. A thorough history, exam, and sometimes labs or imaging might be warranted if true cognitive impairment is present.
To be clear, if you are experiencing symptoms of change in memory, don’t assume it is dementia. Talk with your medical provider; it may be normal or have any of a long list of other causes. Let’s figure it out together.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota.