Majid Fotuhi, MD, PhD
Majid Fotuhi, MD, PhD, a neurologist and medical director at NeuroGrow Brain Fitness Center in McLean, Virginia. He is author of The Memory Cure and Boost Your Brain.
If you or members of your family are concerned about your memory, a thorough neurological exam can determine with 90% to 95% accuracy whether you have normal age-related memory loss or some form of dementia.
Good news: People who are alert enough to worry about their memories are less likely to have significant problems. Declines in memory or cognition that are apparent to others—but not to the patient—are usually more serious.
Key parts of a neurological exam…
Neurologists who specialize in memory loss usually can identify underlying problems from a person’s medical history alone.*
Important: A friend or family member should accompany the patient to a neurological exam to help provide information regarding the patient’s memory and/or lifestyle.
Questions typically asked…
Does the memory loss occur often? People who repeat themselves frequently or repeatedly ask the same question during conversations are more likely to have a significant memory impairment than those who forget only occasionally.
Are there recent triggers? A patient who recently had surgery might be taking a prescription painkiller or sedative that impairs memory. A head injury—even one that occurred years ago—also can result in memory loss, particularly if the patient also has high blood pressure, diabetes or other health problems. These factors—in combination with an old head injury—can have additive effects on the brain that can result in dementia.
Is the patient depressed? Depression can cause trouble with attention and focus, both of which can lead to memory problems.
Is the problem progressing? Memory loss that keeps getting worse or occurs with confusion—such as getting lost in a familiar area—usually indicates an underlying problem, such as dementia.
The Mini-Mental Status Exam (MMSE), which is commonly used to assess memory, evaluates…
Recent versus long-term memory. The doctor may name three common objects, such as an apricot, a flag and a tree, and ask the patient to repeat the objects three minutes later. What the results may mean: In the early stages of Alzheimer’s, a patient might not remember the three objects that were named just minutes earlier, but is probably able to recall details, such as a favorite childhood song or beloved pet, from the distant past.
Orientation. The patient will be asked to state his/her name, the year, season, day of the week and the date. Such questions test a patient’s general awareness. What the results may mean: Orientation can be impaired by medication side effects or substance abuse as well as different types of dementia, such as Alzheimer’s. A patient is more likely to have dementia if he can’t remember major details such as the name of the city where he lives.
Attention span. The patient will be asked to count backward (by sevens) from, say, 100…or to spell a short word, such as “holiday” or “pitcher,” backward. What the results may mean: These tests measure alertness and mental focus. A poor score indicates that a patient might have delirium (a usually temporary decline in mental function due to an acute problem, such as a urinary tract infection) rather than, or in addition to, dementia.
Example: I recently saw in my practice a 102-year-old patient who didn’t know where she was. I ordered a urine test, and it turned out that she had a urinary tract infection. I gave her antibiotics, and two days later she was back to normal.
The neurologist also will perform a physical examination that tests, among other things, reflexes and muscle movements to determine whether the patient has had a stroke or has thyroid problems, heart problems, Parkinson’s disease or other conditions that can contribute to dementia.
Depending on the results of the medical history and clinical exam, other tests, including the following, may be performed…
Imaging tests. A magnetic resonance imaging (MRI) scan can show evidence of a stroke, bleeding in the brain, a brain tumor or brain shrinkage.
Blood tests. Low levels of thyroid hormone and vitamin B-12 (both are detected by blood tests) may contribute to dementia.
*Ask your doctor to refer you, if possible, to a neurologist affiliated with an academic medical center. He/she will be more likely to be up-to-date on the latest research.