Managing Memory Loss

Tips for Healthcare Providers

INITIAL COMPLAINT

Problem:

The initial complaint about memory loss is often the tenth complaint expressed by a patient or a loved-one during a scheduled visit. For this reason, it is often minimized or ignored. Your good medical care can make a big difference.

Common causes include:

  • Mood disorders
  • Stress
  • Overscheduling
  • Pain
  • Medication side effects
  • Alcohol/substance abuse
  • Poor or inadequate sleep
  • Dementia

Solution:

  • “Mrs. Jones your memory complaint is important to me. So, instead of attempting to address it today, I am going to create an extended appointment to focus solely on this concern”

This approach allows you to:

  • Provide excellent care
  • Move onto the next patient
  • Obtain appropriate renumeration.

EVALUATION

Problem:

  • The evaluation of cognitive disorders is rarely a focus for medical school, Residency, NP, or PA education. Therefore, providers often turn to tests that are unlikely to provide answers.

Solution:

  • Focus your efforts on history.
  • Older patients are much more likely to have a degenerative dementia.
  • Younger patients are much more likely to have concentration deficits related to one of the disorders listed above
  • A slow progression of short-term memory loss in an older person makes a degenerative dementia most likely, with Alzheimer’s disease most common.
  • An abrupt change in an older person would indicate stroke or perhaps a delirium instead of a dementia
  • Dementia does exist in younger patients, but this is much more rare. So, the history should focus initially on illnesses that can effect concentration, such as mood, sleep and pain disorders.
  • Brain scans and laboratories are sometimes indicated, but rarely identify a cause for memory complaints. Therefore, they should be deemphasized in the initial workup, particularly, in younger patients. Almost all dementia patients will require either a Brain MRI or CT. However, the results will only rarely change your diagnosis or treatment.

TREATMENT

Problem:

  • Tests are often ordered before, or at the same time treatment is instigated.

Solution:

  • Since brain scans and laboratory tests only rarely identify the origin of memory loss, it makes a lot of sense to treat the problem you have identified as the most likely cause.

This allows for:

  • Quicker intervention
  • Reduced cost
  • Improved patient productivity

DEMENTIA RESEARCH

Problem:

  • Overall, too few patients are being referred for clinical research trials. This is especially true in underserved populations.

This leads to:

  • Slower development of therapeutics
  • Unreliable results for racial and ethnic subgroups

Solution:

  • Create a link with the dementia research center closest to your practice

Explain to patients/families the following concepts:

  • Research is how medications come to the bedside
  • Research is entirely voluntary and without cost to the family or insurance Travel and expense reimbursement is typically offered.
  • Research medications are offered in addition to, not in place of, proven medications, unless it is clearly explained and understood by all parties.
  • Research medications may offer the patient benefit, but participation will definitely help the next generation by either proving the benefit of the compound or removing it from consideration, so that the next medication can be tested.
  • If their particular race or ethnicity is not included in the trial, the results may not represent their community.