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Are you experiencing memory loss? How can I tell if my cognitive problems require evaluation?

When is it time to see a doctor for memory loss? That is a question that is often asked by many people who are trying to determine if their cognitive difficulties or cognitive slip-ups are normal or if they are indicative of something more concerning. The general rule of thumb is that it is best to consult a doctor when memory lapses or cognitive lapses become frequent enough or sufficiently noticeable to concern you or a family member or friends. If the difficulties you are currently experiencing have increased in frequency and severity it is time to reach out to your doctor. If you are experiencing new cognitive difficulties that you have never had previously it is worth while reaching out to your doctor. If you get to that point, make an appointment as soon as possible to talk with your primary care physician or your neurologist and have a thorough examination. Make sure you stress that your cognitive concerns are different than ones in the past and that they have been occurring in a more frequent, progressive manner.

COULD YOU HAVE ALZHEIMER'S DISEASE? For many older adults, one of the worries, concerns, and/or fears that people report to me center on Dementia, in particular Alzheimer's disease dementia. Worrying about Alzheimer's is something more and more of us are doing. Sometimes this is even more exacerbated if we cared for a loved one with Alzheimer's and saw their deterioration over time. Age-related cognitive decline happens to all of us, it part of the natural life cycle. As we get older, we might forget why we went into the kitchen or the name of a character in a movie, TV show, or book. That's normal for most people, until it becomes something that progressively worsens over time. Here are some basics about Alzheimer's and dementia to consider.

Medications, on their own or in combination, may produce delirium or dementia-like symptoms. These symptoms can appear suddenly or over time. People with Alzheimer's tend to exhibit a pattern of increasingly asking the same question or repeating a story over and over again without realizing that they have done so. Brain scans might show some physical/structural changes indicative of Alzheimer's disease, but neurocognitive tests are the only way to objectively measure functional changes. Memory loss is often accompanied by disorientation, a loss of confrontation naming (increased difficulty in the ability to call things by their names), and a loss of executive function (the ability to plan a task and then complete it). For some individuals, changes in personality may also emerge. Someone once very calm and steady may become irritable, sad, anxious, impulsive or apathetic.

What Else Might Cause Memory Impairment or Cognitive Impairment?

1. Medications, on their own or in combination, may produce delrium or dementia-like symptoms. These symptoms can appear suddenly or over time.

2. Thyroid imbalance, hypoglycemia, too much sodium or calcium, dehydration and nutritional deficiencies (e.g., low B12) in cognition and emotional state.

3. Stroke, Brain tumors and bleeding between the brain and its lining can interfere with brain function; so can lack of oxygen to the brain, originating with heart and lung problems. Other health issues, including smoke or carbon inhalation or coma, can have an impact on brain function.

4. The hippocampus, a region of the brain involved in the formation and retrieval of memories, often deteriorates with age. As such, your treating physician may order head imaging to evaluate if there have been any structural and/or volumetric changes in the brain that correlate with cognitive decline on neuropsychological testing.

What Tests Can Help In Diagnosing My Memory Concerns?

1. Physical exam, including blood and organ function tests, along with a complete medical history, is helpful in ruling out a treatable medical condition.

2. MRI, CT and PET scans provide more detail; an EEG (electroencephalogram) tracks electrical activity in the brain through electrodes attached to the scalp. Spinal fluid may also be tested.

3. You can have a quick cognitive assessment in a doctor's office—and that's good, but it's not as sensitive as the whole battery of tests you get in a neuropsychological evaluation. There are many times in which individuals perform within normal limits on a quick cognitive assessment in the doctor office but struggle to perform memory-related tasks in their daily lives. Passing a MMSE or MOCA does not provide the sensitivity needed to truly measure an individuals cognitive profile. The brief cognitive screening tests that are used in the majority of standard medical offices are relatively insensitive in the detection of MCI and the subtle cognitive changes that occur in the early stages of Alzheimer’s disease and other neurodegenerative diseases. Neuropsychological evaluations complete the picture by providing the patient and their treating medical team the ability to differentiate between normal age-related cognitive decline, mild cognitive impairment (MCI), and dementia.

If you live in the New Jersey or New York area and would like to schedule a neuropsychological evaluation for yourself or a family member in order to determine if there have been any potential cognitive-related changes that would be atypical for your age and education please contact Dr. Corey Burchette at 201-577-8286 to inquire about scheduling an appointment at the NJ Memory Center which is located in Verona, New Jersey.

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