Everyone might forget certain things at times. How often have you misplaced your keys or forgotten the names of persons you just met? Memory problems as well as a modest decline in other skills is a major part of aging. However, there is a difference between normal changes in memory and memory loss associated with relevant disorders.
Memory loss or cognitive decline does not only refer to short term memory impairment but it also includes the deterioration of complex motor skills, confusion in time or place, language difficulty, calculation problem, impaired behavior and ability to perform your activity of daily living compared to your normal baseline.
When medical attention is required, the specialized neurologist performs history taking, physical examination and memory tests. Routine blood test and imaging test will be further conducted to rule out secondary causes that can potentially interfere with your cognitive functions. These conditions usually include vitamin B12 deficiency, hypothyroidism, HIV, syphilis, stroke, brain tumor and other brain disorders such as normal pressure hydrocephalus.
After conducting comprehensive neurological examinations, if cognitive decline has firmly developed without other possible causes that can disrupt cognition, the confirmatory diagnosis can be either minor or major neurocognitive disorders, depending on patient’s ability to perform daily tasks and activities.
Alzheimer’s disease is the most common cause of neurocognitive disorders. Nonetheless, there are several different forms of neurocognitive disorders, including vascular dementia, frontotemporal dementia, Lewy body dementia and Parkinson’s disease dementia. Accurate and timely diagnosis serves as a crucial element to guide an appropriate treatment plan and predict disease progression as well as its prognosis.
Special investigations of memory disorders
To precisely diagnose memory disorders, genetic tests, lumbar puncture and special imaging called PET scan may be requested especially if patients have certain indications.
- Genetic tests include:
- APOE gene in patient with Alzheimer’s disease in early onset (less than 65 years old)
- PSEN1, PSEN2 and APP genes in familial Alzheimer’s disease
- C9orf72 gene in frontotemporal dementia
- Lumbar puncture is conducted to evaluate the infection of central nervous system and to investigate abnormal proteins in neurocognitive disorders (beta-amyloid, phosphorylated-tau protein and total-tau protein).
- PiB PET scan/ amyloid PET scan is a special imaging technique using a positron emission tomography (PET) scan with Pittsburgh compound B (PiB) – a radioactive agent to detect beta-amyloid plaques in the brain. Beta-amyloid plaques are abnormal proteins that are usually found in patients with Alzheimer’s disease.
- FDG PET scan is another PET scan using FDG, a glucose analog to assess brain metabolism which is a major biomarker for neurodegeneration. The patterns of decreased brain metabolism widely vary among different types of neurocognitive disorders.
To early detect and prevent the progression of Alzheimer’s disease, PET scan is highly recommended since the abnormalities detected by other imaging tools e.g. MRI are indicative results when patients have already had their clinical symptoms showing up.
Treatment of memory disorders
Currently, definite treatments to stop the disease progression of neurocognitive disorders are not yet developed. However, a number of medications that delay or slow disease progression can significantly improve quality of life of the patients and their families. Early diagnosis remains crucially important to promote early treatments and the best possible outcomes while preserving cognitive functions.
To improve cognitions, neurologists advise patients and families to continue physical activity and cognitive training combined with medical treatments. Trainings are, for example, painting, calculation, playing card and Sudoku. In addition, patients have to avoid falling, control their cardiovascular diseases and infections which can substantially deteriorate disease progression.
Transcranial magnetic stimulation or TMS is an exciting, innovative treatment for patients with neurocognitive disorders. This machine generates magnetic field that induces an electrical current in the brain. TMS is a non-invasive treatment that can stimulate or inhibit neuron cells in the affected part of the brain, depending upon the frequency of the electrical setting. Since it is a non-invasive treatment, patients do not feel any pain during administration. This treatment can be performed as OPD basis. Treatment duration takes approximately 20 minutes to 1 hour, depending on the specified treatment protocols.
More importantly, caregivers and family who take care of patients should have regular check-ups and join a supporting group. It is advised to take some time away from caregiving to maintain personal social activities and relaxation.
For people who have not developed neurocognitive disorders, risks of neurocognitive disorders can be minimized by avoiding head injury, maintaining cognitive activity, having physical exercise, keeping blood pressure, blood sugar, cholesterol and LDL under control, smoking cessation, eating healthy food and avoiding drugs that affect cognitive functions (e.g. sleeping pills and antihistamine drugs). In case that you have depression, it should be treated since it is a contributing factor to Alzheimer’s disease.
Sarinporn Manitsirikul Tipudom, M.D.
Neurologist (Subspecialty: Dementia and Alzheimer’s disease), Neuroscience Center, Bangkok International Hospital.
For more information, please contact: Orthopedic Center, Bangkok International Hospital. Tel: +662 310 3000 or 1719 (local calls only) Email: [email protected]