I often see people worried that they are dementing because their memory isn’t what they feel it should be.
Quite a lot of these patients test out fine on objective tests of attention and memory. They are having a bit of “memory perfectionism” . There is so much more information out there today -there is more than out memory is designed to take in – that’s where “Dr Google comes in” In the age of globalisation and mass media we need to be content to lay off some of the memory work onto out Ipads and Iphones. That is not to say that we should not exercises our minds regularly with things like cross-words , maths puzzles etc to keep in mental trim.
However there are some risk factors for attentional and short-term memory impairment:
- Depression ( the cognitive impairments persist between episodes of depression ) in persons with recurrent depression
- Anxiety Disorder
- Head Injury (even a mild concussional injury can cause cognitive problems + dizziness +headaches + fatigue + irritability for up to 18 months later)
- Schizophrenia ( the cognitive problems become more likely the more frequent the relapses)
- Multiple Chemical Sensitivity
- Sleep Apnoea
- Liver Disease
- Thyroid Disorder
- Post Drug Abuse ( cannabis and amphetamines ) for up to 1 2 months.
- Vitamin and iron Deficiency
- HIV and NMDA Encephalitis
- Some Medications.
- Benign Cognitive Impairment in the Elderly
So the differential diagnoses need to be sorted with biochemical tests, and MRI and Neuro-psychological Testing. The latter is a battery of ten tests or so that tests the various mental skills that are attributable to the various brain systems for example visual memory, and memory for spoken words.
Management obviously depends on treating the cause.
N-Acetyl Cysteine and S-Adenosyl Methione can be beneficial for cognitive impairment and are affordable.
An antidepressant Vortioxetine is helpful with depression based cognitive symptoms.
A rather expensive drug called modafanil is helpful for some forms of cognitive impairment.
Some anti-dementia drugs ( memantine ) also are useful but these also are very expensive.
Erythropoetin infusions have been used with success.
Cognitive remediation is useful and there are packages available on the net such as from rehacom..com.uk and brainhq.com some of which are done by subscription on-line and some of which have packages you can by. Its most useful if you have had a neuropsychological exam which has mapped out your areas of difficulty – the neuropsych exam can then by repeated one year letter to assess progress.
For memory problems there are also particular tricks that can be taught too enhance recall – for instance to recall several items you make up a story that contains all the items you need to remember and tell the story a few times. “Memory Tips And Tricks ” by Castilloga Press (2014) looks OK.