How is memory loss diagnosed?

David A. Merrill, MD
Diagnosis and management of memory loss begins with a thorough evaluation. If you have a loved one you're worried about you can start with a primary care visit. If that’s not sufficient, you may go to a geriatrician, a neurologist, a neuropsychologist or a geriatric psychiatrist.

All these specialists will basically perform a similar type of evaluation that begins with a clinical interview, a history and an evaluation. They will do a mental status exam or a screening mental test (the most common example being a test to try to remember three words).

The doctor will then do a physical examination and get any additional information from the person’s loved ones, followed by a thorough psychosocial assessment of the situation -- namely how things are going at work, at home and in the person's relationships. After the initial appointment, the person will be sent for lab studies such as brain imaging, and if needed, neuropsychological testing.
Memory loss is diagnosed clinically both by what the patient and what the family members report. An initial exam by a neurologist will include a brief mini-mental status exam which may not pick up the memory loss if it is subtle. That is why they will often refer the patient for a 4-8 hour neuropsychological assessment which will look at numerous cognitive domains including verbal memory, visuospatial memory, calculation, and motor processing to name a few. Certain patterns of impairment are suggestive of different dementing illness such as Alzheimer's disease, Lewy Body Dementia, Frontotemporal Dementia and Vascular Dementia.

Reversible causes for memory difficulties such as vitamin B12 and Folate Deficiency, Hypothyroidism, and neurosyphilis are frequently evaluated by blood labs.

The idea that it is normal to lose memory as one ages is not correct. Memory loss is always a result of some abnormal body processes. 

Stella and Ruth, both 75 years old, were identical twins. Both had two copies of the Alzheimer’s vulnerability genes (APO-E4). Ruth had Alzheimer’s disease from the age of 65, and Stella, my patient, was sharp as a tack. Same genes, different outcome. How can this be?

The answer is, in fact, simple: lifestyle. Stella ate very well, didn’t smoke, didn’t drink, and exercised regularly. Ruth, however, ate poorly, was overweight, and was a smoker. She developed diabetes. As a result, she had a chronic state of inflammation in her body—like a slow burn—which in combination with her genes produced a disease, which we call Alzheimer’s. Ten large studies have shown that the risk of Alzheimer’s disease is sharply reduced when inflammation is controlled.

How do we control inflammation? Lifestyle. So, while we are waiting for a vaccine to come along, I suggest that you work on your lifestyle if you are concerned about dementia. Eat healthy wild fish (haddock, cod, ocean perch, herring, salmon, sardines, tilapia, trout, whitefish), lots of colorful organic vegetables and fruits, and organic grains in moderation. Skip the bread, alcohol, and cigarettes too.

There are a variety of causes of memory loss including normal aging, depression, dementia, Alzheimer’s, alcohol use, brain injury whether it be due to surgery or unintentional, cancer treatments, seizures, illnesses which damage nerve cells like Parkinson’s, medications and illicit drugs, and nutritional deficiencies like low Vitamin B12 levels. Diagnosis to see what is the cause of memory loss will include a very thorough history and physical exam by a physician. History will be taken from the patient as well as family and friends. A detailed test of thinking and memory will be performed as well as an exam of the nervous system. Often cognitive or psychotic tests may be done. Blood tests to check for specific diseases that could cause memory loss such as thyroid problems or low Vitamin B12 can be performed. Imaging such as a CT scan or MRI of the head may be done as well as lumbar punctures, EEG’s, or CT angiography which evaluates the blood vessels in the head and neck. Those involved in diagnosing memory loss may include primary care physicians, neurologists, geriatricians, or psychologists.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.