With an ongoing increase in life expectancy in the United States (e.g., National Vital Statistics Report, 2012, females: 81, males: 76) more and more individuals are experiencing or reporting daily forgetfulness or memory loss. Reduced cognitive efficiency, especially in areas of processing speed, sensorimotor abilities, and memory, are common in normal aging. Thus, these perceived problems or concerns do not necessarily coincide with a dementing process such as Alzheimer’s disease or other dementias (e.g., vascular dementia, dementia with Lewy bodies, mixed dementia, including Alzheimer’s and vascular, or frontotemporal lobar degeneration).
As noted above, individuals who subjectively report daily forgetfulness are often experiencing a byproduct or consequence of normal aging. However, if problems persist and specific medical conditions which are known to produce transient cognitive problems (e.g., forgetfulness, memory loss) such as diabetes mellitus, hypothyroidism, adverse medication effect, and even depression, are ruled out, then additional medical evaluation and formal neuropsychological assessment might prove beneficial in delineating a specific etiology.
Mild cognitive impairment (MCI) has received increased notoriety in the medical literature as a potential explanation for daily memory problems. MCI is considered a stage between forgetfulness associated with normal aging and dementia (e.g., Alzheimer’s disease). Specific diagnostic criteria for MCI includes:
- Subjective complaints of memory loss or reduced cognitive efficiency
- Normal score on the Mini-Mental State Examination (MMSE)
- No impairment in an individuals activities of daily living (ADL)
- Impairment (< 1.5 standard deviation below the mean) on a standardized single neuropsychological measure
Three specific subtypes of MCI are noted and include groups with amnesia (e.g., forgetfulness), amnesia with language problem and those with deficits in processing speed and executive functions (e.g., insight, reasoning, organizational skills). Individuals diagnosed with MCI will either improve, stay essentially the same, or get worse over time. The latter group of individuals will likely be diagnosed with some form of dementia within 3 years. This is especially borne out in individuals who are noted to have medial temporal atrophy on formal neuroimaging such as cerebral MRI or CT scan.
Dementia, per se, is not considered a specific disease, but rather a combination of symptoms involving reduced cognitive ability and limitations imposed in daily functioning. Since many dementias are progressive and result in a gradual decline in functioning (e.g., operating an automobile, balancing a checkbook, meal planning and preparation), it is imperative that an accurate diagnosis be made in order to establish the most effective treatment plan and to provide family education.
In conclusion, daily forgetfulness is commonplace in an aging population (e.g., normal aging). Remember, at one time or another, every individual will misplace their car keys, forget someone’s name, or have difficulty recalling a piece of information during a recent conversation. This does not necessarily mean that you or a loved one is experiencing the onset of MCI or a more progressive dementia. However, if problems persist and cause undue concern, formal medical assessment is warranted. This might include, but not be limited to a physical examination by your primary care physician, laboratory tests, neuroimaging, and neuropsychological assessment. Don’t forget, it’s better to be safe than sorry.
For more information on mild cognitive impairment, please refer to a recent segment on WVIA’s Call The Doctor (3/27/12) in which Dr. Raymond was one of the invited panelists.