Memory Loss

Often doctors and patients are concerned that memory loss could indicate an impending dementia. This concern is based on the general recognition that memory deficits typically are the first signs of dementia. However, memory loss is not synonymous in most cases with the onset of dementia.

Forgetfulness is a common complaint in the context of primary medical care union. It is especially common in older people, but it can also be reported by younger people. Sometimes tell family members instead of the patient about his memory loss (this is usually an older person, often with dementia). Often doctors and patients are concerned that memory loss could indicate an impending dementia. This concern is based on the general recognition that memory deficits typically are the first signs of dementia. However, memory loss is not synonymous in most cases with the onset of dementia. The most common and earliest occurring complaints of memory loss are usually difficult to remember the name, the place where the car keys or other frequently used objects With increasing memory loss is then forgot to pay bills or to comply with deadlines. People with severe memory impairment can make dangerous errors such. As forgetting to turn off the stove to complete the house when leaving or taking care of a baby or a child who is in their care. Other symptoms (eg., Depression, confusion, personality changes, difficulty in activities of daily living) may exist according to the cause of memory loss. Etiology The most common causes of memory loss (characteristics of the main causes of memory impairment) age-related memory disorder (most common) Mild cognitive impairment Dementia Depression age-associated memory impairment related to the deterioration of memory that occurs with aging. When people in this state, it takes longer to form new memories (z. B. Name of new neighbors, new computer password) and new complex information and skills to learn (z. B. workflows, computer programs). Age-related changes in memory lead to occasional forgetfulness (z. B. misplaced car keys) or embarrassment. Cognition is not affected. Patients in this state enough time to think, they can answer Asked usually questions, indicating an intact memory and cognitive functions intact. Patients with mild cognitive impairment actually have a memory loss and not as matched controls subjects, sometimes a slow memory retrieval from a relatively conserved Gedächtsnisspeicher. Mild cognitive impairment affects short-term memory (episodic memory). Patients have problems getting out of talks recently, the place where the most frequently used items and dates to remember. The memory of other less recent events, however, is usually intact, as is the attention (also called memory-patients can repeat word lists and solve simple arithmetic problems). The concept of mild cognitive impairment evolves; He is now in part defined as a reduction of Gedächtsnis and / or other cognitive functions that are not sufficient to affect the everyday activities. Up to 50% of patients with mild cognitive impairment develop dementia within 3 years. Patients with dementia characterized by memory impairment plus evidence of Fehlfuntionen in cognition and behavior. You can, for. B. difficulties have word finding and / or naming objects (aphasia), in the execution of earlier learned motor activities (apraxia), or in the planning and organization of everyday activities such as meals, shopping and paying bills (impaired executive function). Your personality can be changed; z. As they can unusually irritable, anxious, restless and / or inflexible. Depression is common in patients with dementia. However, depression can cause memory problems on their part, the dementia pretend (pseudo dementia). Such patients have other features of depression generally. Delirium is an acute confusional state of a severe infection, a drug (adverse effect), or drug withdrawal may be caused. Delirpatienten have memory impairment, although not the main cause, in contrast to the heavy usually global changes in mental status and cognitive dysfunction. Characteristics of the main causes of memory impairment due suspects findings Diagnostic approach age-associated memory impairment Occasional forgetfulness (z. B. name or repository of car keys), but no further impairment of memory. Normal cognitive function Clinical examination Mild cognitive impairment memory impaired daily functions are not affected more aspects of cognition intact Clinical examination Sometimes neuropsychiatric testing dementia memory affects everyday functions impaired (z. B. in the surrounding area to find the way or perform usual tasks at work) reduction of at least a further aspect of cognition: impaired reasoning and the handling of complex tasks (executive function), and poor judgment (for example, not in the lag manage e his bank account to make bad financial decisions) aphasia (language dysfunction), causing difficulty in finding words and / or naming objects visuospatial dysfunction (eg. to recognize as inability faces or common objects) personality and behavior changes (eg. as distrust, anxiety, restlessness) Clinical examination Sometimes neuropsychiatric testing depression memory loss often correlated with often available with the severity of mood disorder sometimes insomnia, loss of appetite, psychomotor retardation patients with dementia, mild cognitive impairment or age-related memory disorders Clinical study drug use (eg. as anticholinergics, antidepressants, opioids, psychotropic drugs or sedatives) taking a potential else causing the drug (affects recent initiation of drug therapy, increasing the dose or slower drug clearance z. As by removing the kidney or liver function) Typically attempt to depose the allegedly causing drug or switch rating The highest priority is to detection of delirium, which requires rapid treatment. The investigation aims to distinguish the few cases of mild cognitive impairment and early dementia of the more common age-related memory changes or normal forgetfulness. The complete investigation of dementia usually requires more time than the 20 to 30 minutes, usually available for a consultation available. History The history should be possible away from the patient or collected by the family members. Cognitively impaired patients may not be able to provide a detailed and accurate medical history, and family members may not feel free to report honestly about while the patient listens. The history of existing disease should include a description of the type of memory impairment (eg. As words or names are forgotten, the patient gets lost) and their onset, severity and course include. The clinician should determine how many symptoms affecting the suitability for everyday use at work and at home. Important related findings are changes in language use, when eating, sleeping and in the mood. The review of organ systems should identify neurological symptoms that points to a specific form of dementia, such as the following: Parkinson’s symptoms in Lewy body dementia Focal deficits in vascular dementia to look inability upwards and progressive supranuclear palsy chorea-like movements Huntington’s gait at normal pressure hydrocephalus balance problems and difficulty with fine motor movements in vitamin B12 deficiency the medical history should include known diseases, and the use of all prescription drugs and over the counter preparations. Family and social history should determine the initial level of the patient with regard to intelligence, training, employment and social functioning. Former and current substance abuse are detected. The incidence of dementia or early mild cognitive impairment in the family is erfragt.Körperliche investigation Besides a general performed a complete neurological examination with a detailed examination of mental status. When tested in mental status of the patient is asked to perform certain tasks. be assessed the following areas: orientation (your name, date and place of residence) attention and concentration (. eg .: repeat a word list, perform simple calculations, you spell “evening” backwards) short-term memory (eg .: repeat. a list of three or four items at 5, 10 and 30 minutes) language (z. B. naming everyday objects) praxis and executive function (z. B. Follow a multi-stage instruction) Constructive skills (eg. as copying a form or drawing a clock face) Different scales can be used for testing these components. This is the Mini-Mental State Examination most common; Duration about 7 min.Warnhinweise The following findings are of particular importance: Troubled everyday functions loss of attention or altered level of consciousness symptoms of depression (eg, loss of appetite, psychomotor retardation, suicidal ideations.) Interpretation of the findings, the presence of actual memory loss and impairment of daily activities as well as other cognitive functions help in the differentiation of age-related memory changes, mild cognitive impairment and dementia. Mood disorders are in patients with depression, and are also common in patients with dementia or mild cognitive impairment. Thus, the differentiation between depression and dementia can be difficult so long until the memory problems are serious or other neurological deficits occur (eg. As aphasia, agnosia, apraxia). Attention deficits help in differentiating delirium and early dementia. For most Delirpatienten memory problems are not a symptom. Nevertheless delirium must be excluded before the diagnosis of dementia can be made. A helpful hint here provide the circumstances under which the patient came in medical check-treatment. If the patient initiates the medical clarification because he is anxious to be forgetful, age-related memory disorders as the cause is likely. has done a member of a patient even less worried about his memory gets when his family, dementia is much wahrscheinlicher.Testing The diagnosis is primarily clinical. Each brief examination of mental status is, however, influenced by the intelligence of the patient and his level of education and thus has limited accuracy. Patients with high levels of education can,. B. mistakenly cut off those too good to bad low. In unclear diagnosis more accurate formal neuropsychological testing can be carried out, the results have a higher diagnostic accuracy. When a drug is suspected as the cause, it may be discontinued or in the diagnosis replaced by another. Are seemingly depressed patients treated, this can facilitate the differentiation between depression and mild cognitive impairment. In patients with neurological abnormalities (eg. As weakness, gait disturbance, involuntary movements) are MRI or CT required. In most patients, a vitamin B12 deficiency and thyroid disorders must be ruled out as a reversible causes of memory problems by serum determination of vitamin B12 and thyroid function tests. If a delirium or dementia before, further tests should be performed to determine the cause. Therapy patients with age-related memory disorders should be reassured. Some healthy in general measures are often recommended to maintain function and reduce potentially the risk of dementia. Patients with depression are treated with medication and / or psychotherapy. Patients with memory disorders and symptoms of depression should be treated with antidepressants nichtanticholinergen, preferably with SSRIs. With the decline of depression and memory loss is declining. Delirium is treated causally. Rare dementia can be reversed by a specific treatment (for. Example, substitution of vitamin B12 or thyroid hormone, shunt at normal pressure). The remaining patients with memory loss supportive treatment. General measures The following can be recommended for patients who have the fear of memory loss: Regular exercise A healthy diet rich in fruits and vegetables Getting enough sleep No smoking, the use of alcohol in moderation participation in social activities and those that promote mental alertness Regular physical investigations stress management prevention of head injuries These measures, which include the control of blood pressure and cholesterol and plasma glucose levels also tend to reduce the risk of cardiovascular disease to decrease. Some evidence suggests that these measures can reduce the risk of dementia, but these effects were not detected. Some experts recommend to learn new things (eg. as a new language, a new musical instrument) to perform mental exercises (eg. as Memory lists, crossword puzzles, playing chess, bridge and other games, the strategies used), reading, working on the computer or crafts (eg. as knitting, quilting). These activities can help maintain cognitive function or improve, possibly because they strengthen neural connections and fördern.Patientensicherheit To prevent new connections falls and other accidents, the patient’s affected dwelling by occupational and physical therapists can be checked for safety. Here protection measures (eg. As put away knife off power to the oven, remove the car, car keys confiscated) are necessary. In some cases, the doctor must turn on the driving license office at Demenzpatieten. If patients wander or run away, monitoring systems can be installed, or patients can be registered in the “Safe Return Program.” (Editor’s note: In Germany there is no analog to the “Safe Return program,” but are used positioning systems, the transmitter, for example in a lockable watch or a key chain are located and their signal, then on a cell phone, laptop.. or the switching center of the location system provider is received) information on the Alzheimer society (safe Return program) (Notes from editor:.. for Germany, for example, German Alzheimer’s society; www.deutsche-alzheimer.de). Finally aids can (eg. As home help, home care) or an adaptation of the environment (eg. As barrier-free apartment, assisted living, nursing station) appears sein.Maßnahmen to adapt the area of ??environmental protection measures can help patients with dementia. Dementia patients works best for you in familiar surroundings in general, the orientation should be reinforced again and again (incl. Large calendars and clocks), and in a bright and friendly environment with a regular routine. The room should senorische stimuli offer (eg. As radio, television, night light). In homes, employees can wear large name tags and imagine again and again. Changes in the environment of processes or persons should be precisely the patient and simply explained the omission of minor operations. Frequent visits by nurses and by people familiar encourage the patient to adhere to social contacts. Activities can have a positive effect; they should be fun and stimulating, but do not include too many choices or challenges. Balance exercises and cardiovascular training can also help to reduce anxiety, improve sleep, and to control the behavior. Employment and music therapy contribute to maintain fine motor control, and include non-verbal stimulation. Group therapy (eg. As memory therapy, group activities) can help the linguistic and interpersonal relations beizubehalten.Arzneimittel Discontinuation or reduction of drugs with central nervous system effects often improves function. Sedative and anticholinergic drugs that rather worsen dementia should be avoided. The cholinesterase inhibitors donepezil, rivastigmine and galantamine are effective to improve cognitive function in patients with Alzheimer’s disease or dementia with Lewy bodies, to some extent, and may be useful in other forms of dementia. Memantine, an NMDA (N-methyl-D-aspartate) antagonist may be used in moderate to severe dementia. Donepezil, galantamine and rivastigmine a temporary improvement in memory in patients may be accomplished with mild cognitive impairment, however, the benefit appears moderate. To improve cognition or memory in patients with mild cognitive impairment donepezil, galantamine and rivastigmine are recommended. . Drugs for the treatment of Alzheimer’s disease and possibly other forms of dementia Name Initial dose maximum dose Comments donepezil 5 mg 1 times daily 23 mg 1 time daily general well tolerated, but nausea or diarrhea can cause galantamine (Editor’s Notes: barks red list it galantamine nutrals sustained-release [8, 16, 24 mg], or as a solution [4 mg / ml]) 4 mg 2 times (in Germany daily solution) Retardpräpara t: 8 mg once daily in the morning 12 mg two times a day (solution) Retardkapseln: 24 mg once daily in the morning Influenced behavioral problems may be better than other drugs Modulates the nicotine receptors seems the release of acetylcholine to stimulate and increase the effect of memantine 5 mg of 2- to slow down times daily 10 mg 2 times daily appears disease progression rivastigmine solution or capsule: 1.5 mg 2 times daily TTS: 4.6 mg / 24 h or capsule solution: 6 mg 2 times daily TTS: 13.3 mg / 24 h Also available as a liquid solution Geriatric Basics mild cognitive impairment is common in old age. The prevalence is after the age of 70 between 14% and 18%. Dementia is a leading cause of institutionalization, morbidity and mortality in the elderly. The main risk for dementia is age. The prevalence of dementia About 1% aged between 60 and 64 from 30 to 50% at age> 85 60-80% among the elderly nursing home residents Points to memory loss and dementia are common and in the elderly often cause concern. Age-related memory disorders that lead to slow, but not to the power loss in memory and cognition, are common. The diagnosis is primarily determined by clinical criteria, in particular mood, attention, presence of a genuine memory loss, impact on daily life functions. A complete drug history is critical because sedatives and anticholinergics can lead to memory loss, which can be reversed by stopping the drug. reported by the patient memory problems usually stem not from her dementia. Delirium must be ruled out before the diagnosis is made dementia. More information Alzheimer’s Association

Health Life Media Team

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