Why Should You Pay Attention to Memory Problems?
Do you or a family member struggle with memory problems? You’re not alone. Memory loss is becoming increasingly common, affecting millions of individuals across the United States. Currently, an estimated 6.7 million adults are living with Alzheimer’s disease—a number projected to double by 2060 [1]. Even more people are impacted by Mild Cognitive Impairment (MCI), an early stage of memory loss that’s often overlooked.
What’s more, memory issues are no longer limited to older adults. Cases among individuals under 65 are on the rise, making it vital to recognize when memory problems begin and take action early. Left unaddressed, these issues can sometimes progress into degenerative brain diseases that significantly impact quality of life.
If you’ve been following my blog, you will recognize a recurring theme. I prioritize issues where meaningful steps can make a difference, and memory loss is one of them. Recent peer-reviewed research highlights the effectiveness of systems biology approaches in addressing Mild Cognitive Impairment (MCI) and dementia [2, 3, 4]. In other words, the viewpoint that there is nothing that can be done medically to improve dementia and MCI is outdated.
There are actionable solutions, but if you don’t diagnose the problem, then early action steps can’t be taken. This post is my advice on the initial steps to take if you are worried about memory problems.
Understanding Mild Cognitive Impairment (MCI) and Dementia
Mild Cognitive Impairment (MCI) and dementia both involve declining cognitive abilities, such as memory issues, forgetting common words, and other thinking skills. However, in MCI, the problems are not severe enough to interfere significantly with daily life. Unfortunately, about one-third of people with MCI due to Alzheimer’s disease develop dementia within five years of diagnosis.
Dementia is defined as a decline in mental abilities that is severe enough to interfere with day to day tasks. When a person has advanced dementia, the diagnosis is easy, as the symptoms are apparent and often require immediate action. Most memory issues, however, are subtle, so early recognition requires you to be proactive and not assume that frequent forgetfulness is a normal part of aging.
What Causes Dementia?
When people hear the word “dementia”, Alzheimer’s disease is the first condition that comes to mind. While it is the most common type, it’s far from the only cause. Dementia can result from a variety of factors, often occurring together to contribute to significant memory impairment.
For example, a history of concussions, strokes, or other neurological injuries can increase the likelihood of developing dementia. Understanding these contributing factors is key to identifying when to be concerned about memory loss and taking steps to address treatable conditions.
What are the Types of Dementia?
Dementia is not a one-size-fits-all condition. While Alzheimer’s disease is the most recognized type, there are several others, each with unique characteristics and causes:
- Alzheimer’s Disease: The most common type, marked by memory loss, confusion, and difficulty with problem-solving and daily tasks.
- Vascular Dementia: Caused by reduced blood flow to the brain, often due to strokes or other vascular conditions. It can affect memory, reasoning, and other cognitive abilities.
- Lewy Body Dementia: Linked to abnormal protein deposits in the brain, this type is associated with memory issues, sleep disturbances, and visual hallucinations.
- Frontotemporal Dementia: Affects the frontal and temporal lobes of the brain, leading to changes in behavior, personality, and language abilities.
- Mixed Dementia: In some cases, a person may have a combination of dementia types, such as Alzheimer’s and vascular dementia, which complicates symptoms and treatment.
- Other, Including Huntington’s Disease: Certain rarer conditions, like Huntington’s disease, can also cause dementia. These cases often involve genetic factors and progressive neurological damage, leading to memory problems and cognitive decline.
Understanding the different types of dementia is key to tailoring medical care and addressing specific challenges, whether they relate to memory, behavior, or daily functioning.
Focus on What’s Treatable
While we can’t turn back the clock and undo a traumatic brain injury or a series of strokes, there are treatable conditions that can significantly impact cognitive function. If you or a loved one are dealing with memory issues, it’s crucial to identify these underlying factors.
These are actionable items (i.e. treatable) that should not be missed and can be readily recognized and diagnosed in the conventional medical setting with insurance-based lab testing.
- Alcohol-Induced Cognitive Decline – Long-term heavy alcohol use can lead to memory impairment. It’s important to consider how much alcohol is being consumed regularly, as it can also be one of the causes of memory loss.
- Vitamin B12 Deficiency – A common yet often overlooked condition that’s simple to diagnose and treat.
- Normal Pressure Hydrocephalus (NPH) – A buildup of cerebrospinal fluid in the brain’s ventricles that causes cognitive decline. On a CT scan, this appears as brain tissue being compressed by fluid.
- Metabolic or Endocrine Issues – Conditions such as liver or kidney failure, severe hypothyroidism, low sodium or high calcium levels can contribute to memory problems.
- Infections (Rare)– Although uncommon in North America, conditions like neurosyphilis or HIV can cause dementia and should be ruled out.
- Depression (Pseudodementia) – Depression can mimic dementia symptoms and is an often-overlooked but treatable cause of cognitive decline.
By addressing these treatable conditions, you can take proactive steps toward improving cognitive health and preventing further decline.
My Advice for Early Action
If you feel that your memory has deteriorated, I highly recommend that you review the simple steps outlined below so you can advocate for yourself or a family member. Prioritizing brain health starts with being proactive, and since medical visits are becoming shorter due to insurance constraints, it’s essential to have a game plan before meeting with your doctor. This is especially important when multiple medical conditions, like diabetes or high blood pressure, must be addressed during a short appointment. The unfortunate reality is that less pressing issues, such as a report of memory decline, can sometimes get deferred due to lack of time in the exam room. Since early diagnosis plays a crucial role in addressing memory issues and taking steps to improve brain health, it all starts with the initial evaluation. With this plan, you’ll have the tools to ensure a thorough early evaluation for memory loss.
Step 1 – MoCA Testing
When visiting a doctor or health practitioner, make sure they know that you are concerned about memory issues. If they do not suggest any testing to further work up the problem, I recommend that you clarify that the memory issue is a real concern and ask if they could order a MoCA (the Montreal Cognitive Assessment) for you. The MoCA takes 10 minutes to do and is a heavily validated assessment tool for detecting early signs of dementia and mild cognitive impairment. The MoCA tests multiple domains of cognition, making it a very useful screening test when there are concerns of memory loss.
The MoCA test looks at the following cognitive domains, including:
- Memory
- Attention
- Executive Function (problem solving and decision making)
- Language (verbal fluency and your thinking abilities)
- Visuospatial Skills (drawing and pattern recognition)
- Orientation (awareness of time and place)
Many health practitioners are certified to administer and score the MoCA, but only health professionals with training in the cognitive field are permitted to interpret the results and explain what the results actually mean.
MoCA tests are scored out of 30 points. A score of 26 or higher is generally considered normal. A score in the range of 22-25 is suggestive of MCI. A score below 22 could indicate more severe cognitive issues such as dementia.
Step 2 – Blood Testing
A comprehensive blood draw is the next step and this is a crucial part of recognizing reversible causes of memory loss. Important lab tests include:
- CBC (Complete Blood Count): Helps evaluate overall health and detect conditions like anemia or infections.
- Electrolyte Panel: Ideally, ask for a Comprehensive Metabolic Panel, which includes kidney and liver function assessments.
- Hemoglobin A1c: Screens for diabetes or prediabetes, conditions that can impact brain function and memory.
- Thyroid Panel: At a minimum, ensure this includes TSH (Thyroid-Stimulating Hormone) and Free T4 levels to detect thyroid dysfunction, which is often linked to memory issues.
- Vitamin B12 Level: This is extremely important, as B12 deficiency is common, frequently overlooked, and easily treatable. Low levels can directly affect memory and thinking skills – you want your B12 level to be 500 pg/mL or above.
- RPR (Syphilis Test): Though rare, syphilis infections can cause cognitive symptoms and should be ruled out.
- HIV Test: Similarly, HIV can occasionally lead to memory issues and warrants testing in cases of unexplained cognitive decline.
Step 3 – Brain Imaging
The need for brain imaging is something that you would discuss with your health practitioner. Imaging of the head to rule out a structural abnormality, such as a CT scan or MRI, is not indicated for most cases of asymptomatic mild memory loss. Brain imaging is, however, indicated for a newly diagnosed case of dementia. Certain situations would make your health practitioner more likely to want imaging early on. These scenarios include but are not limited to:
- Suspected Normal Pressure Hydrocephalus (NPH) – Suspect when there is a problem with balance, gait (shuffling the feet when walking) and urinary incontinence together with memory loss.
- Atypical Headaches
- Seizure History
- Recent Trauma – If there has been a history of head injury or other physical trauma, it’s important to rule out conditions like hematomas or other injuries impacting the brain.
The Bottom Line
Early recognition of Mild Cognitive Impairment (MCI) is important to allow for timely intervention and treatment. Many cases of cognitive decline are linked to reversible causes, such as vitamin B12 deficiency, which are often overlooked but easily addressed. If you are concerned about memory loss, the 3 initial steps I recommend you discuss with your health practitioner are:
- MoCA Testing – A quick and validated assessment for early signs of cognitive impairment.
- Targeted Blood Work – To identify treatable conditions that may be affecting memory and brain health.
- Brain Imaging – When necessary, to rule out structural abnormalities or other serious concerns.
References
[1] Alzheimer’s Association. 2024 Alzheimer’s disease facts and figures. Alzheimer’s Dement. 2024;20(5):3708-3821. doi:10.1002/alz.13809
[2] Bredesen DE, Ross MK, Ross S. Sustained Cognitive Improvement in Alzheimer’s Disease Patients Following a Precision Medicine Protocol: Case Series. Biomedicines. 2024; 12(8):1776.
[3] Bredesen, D. E., Toups, K., Hathaway, A., Gordon, D., Chung, H., Raji, C., … & Jarrett, M. (2023). Precision medicine approach to Alzheimer’s disease: rationale and implications. Journal of Alzheimer’s Disease, (Preprint), 1-9.
[4] Sandison, H., Callan, N. G., Rao, R. V., Phipps, J., & Bradley, R. (2023). Observed improvement in cognition during a personalized lifestyle intervention in people with cognitive decline. Journal of Alzheimer’s Disease, 94(3), 993-1004.
2024 Alzheimer’s disease facts and figures. Alzheimers Dement. 2024 May;20(5):3708-3821. doi: 10.1002/alz.13809. Epub 2024 Apr 30. PMID: 38689398; PMCID: PMC11095490.
CDC About Dementia link: https://www.cdc.gov/alzheimers-dementia/about/index.html
