Forgetfulness

16 Forgetfulness


Forgetfulness and loss of memory are common complaints, particularly in elderly patients. Often their families raise the issue. Age-associated memory impairment (AAMI) is an impairment in episodic memory that occurs in older patients without evidence of dementia. Age-associated cognitive decline (AACD) has now been described as a more severe impairment than AAMI. Patients with AACD have more extensive cognitive impairment than their contemporaries. The condition is more likely to progress to Alzheimer’s disease than AAMI. Gradual loss of memory in otherwise healthy elderly individuals is so common that it was previously referred to as benign senescent forgetfulness (BSF). Nevertheless, patients are usually concerned that it might be an early sign of Alzheimer’s disease (AD).


The most common causes of forgetfulness are AAMI, AACD, depression, alcohol, substance abuse, medications (particularly psychotropic drugs), and Parkinson’s disease. Forgetfulness can also be caused by dementia, especially AD, frontotemporal dementia, and Lewy body dementia.


When patients complain of forgetfulness, particularly if they appear to be unreliable, it is essential to seek out someone more reliable, such as a friend or spouse, who can confirm the details of the patient’s forgetfulness. Although loss of memory and concentration may have a functional rather than organic origin, the clinician must not assume one or the other without an adequate assessment. This assessment must include adequate history, physical examination, and especially a mental status examination or a computerized test for mild cognitive impairment.



Nature of Patient


When adolescents or young adults complain of forgetfulness, memory impairment, or loss of concentration, the most likely causes are severe anxiety, depression, alcohol abuse, and substance abuse. In a middle-aged person who is not suffering from depression, a sudden onset of forgetfulness should suggest an organic cause such as alcohol abuse, drug abuse, administration of psychotropic agents, brain tumor, or the onset of a dementing process.


In a healthy patient older than 50 years, gradual impairment of memory is probably caused by AAMI when it manifests as problems with everyday activities such as misplacing objects and forgetting the names of persons, multiple items to be purchased, or tasks to be done. In this age group a sudden loss of memory is more likely to reflect a serious etiology, including stroke (cerebrovascular accident [CVA]), intracranial hemorrhage, and brain lesions (e.g., tumor, normal pressure hydrocephalus). AD tends to have a familial incidence. A gradual onset of cognitive impairment and/or dementia may be caused by multi-infarctions, hypothyroidism, Parkinson’s disease, alcoholism, subdural hematoma, and normal pressure hydrocephalus.


Repeated head trauma (e.g., that experienced by boxers) may cause memory loss. If the patient is an alcoholic or substance abuser or has a history of treatment with psychotropic drugs, particularly tranquilizers and hypnotics, impaired memory and concentration can result.



Nature of Symptoms


It is particularly important to note whether the onset of memory impairment was sudden or gradual. A sudden onset may suggest administration of psychotropic agents (e.g., benzodiazepines, hypnotics), a grieving process, stroke (cerebrovascular accident), or head trauma. A gradual onset (or sudden onset less frequently) suggests depression, progressive dementia, AD, Parkinson’s disease, or a deteriorating medical disorder (e.g., cardiac, respiratory, renal, or liver disease). Loss of concentration, which may be confused with memory impairment, is a cardinal symptom of depression.

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Mar 21, 2018 | Posted by in BIOCHEMISTRY | Comments Off on Forgetfulness

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