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I forget things...

I am distracted, I do not remember names, I find it difficult to find words to communicate, or sometimes I have become disoriented... Today I would like to talk to you about the different diagnoses we usually reach when patients consult us for these reasons.

During my training as a geriatric medic, memory and behavior were something that always caught my attention. When you are a resident and you rotate through different hospital departments or you are in the emergency room, memory failures, delirium and dementia are the order of the day. Differentiating, identifying and treating them makes this specialty, psychogeriatrics, a challenge. It is amazing how the brain can put you through such unexpected situations, and not only the sufferer of these symptoms, but also the family, who do not understand what is happening.

I can think of three possible situations that we can encounter:

1. On the one hand, there are those cases in which a family member or person close to us begins to speak incoherently for the first time and without warning. It is then when a series of thoughts come to our head: What is happening? Will he recover or is it for good? But...if he was fine, it never happened to him before, why is it happening now?

2. On the other hand, there are those cases in which we begin to take the first steps on an unknown path. We begin to notice small memory failures in a punctual and very subtle way. We may fail in small things, we may not remember some recent conversations and situations we have experienced. We start to wonder if it's an age thing and it is within the expected for someone like me, or if I should go to the doctor because it may not be normal.

3. Finally, there are those who have already come a long way, a road that can often be hard and not easy to travel. A road, with many feelings in between, in which we see our relative gradually losing autonomy... Will it be the last admission? How will he be after this?....

These are some of the many questions we can ask ourselves when we begin to realize that the person next to us or our own head begins to fail.

Many times it is not memory that is affected in the first place, it can be behavior, language, language comprehension, mood, sleep, even personality.

Do we all age the same? 

When we talk about brain aging, we must know that this is a very complex process in which there is a significant variability, resulting from the interaction of different factors, both external (e.g. environment) and internal (e.g. genetics).

Is it normal to lose memory as you get older? 

"It's just that your father is 90 years old, what do you expect?" "He's 80 years old and his head is going a little, but of course, that's normal at that age" I hear these types of phrases every day from patients' relatives as well as from my own medical colleagues. And the truth is...

Answering the question: No, no and no. I like to emphasize this a lot. The correct thing to say would be that it is common in older people to see memory lapses, but that does not mean that it is normal and that we should therefore not attach importance to it.

It is clear that they are frequent alterations at that age and that the infrequent are those people to whom we refer to as exceptional or resistant aging. People who are nowadays octogenarians or nonagenarians who continue working, winning awards, writing books, making films, etc.

But there are also several people who show resilience (ability to adapt to adverse situations). People who, when they present a brain damage, are able to adapt to it in such a way that their performance is not affected in their daily life. 

What do we call Subjective Memory complaints?

It is a very frequent reason for consultation. It is usually people over 60 years of age who come to the clinic saying that they believe they are suffering from memory loss and that they have the feeling of having a lower performance than people of the same age.  

It is usually a concern that is repeated over time, but it is subtle, as they tend not to forget important appointments or news. 

In the consultation, the results of the neuropsychological assessment are within the normal range. However, we always recommend a yearly check-up or earlier if a family member detects any worsening. 

If this happens to us, it is time to start being active if we are not, and follow some recommendations which we will discuss in a later chapter. 

What is Cognitive Impairment?

This is a syndrome (set of signs and symptoms) characterized by a loss of memory and / or other cognitive functions of the person that can be verified by the patient and confirmed by the family / caregiver. 

In the consultation in this case, when performing the neuropsychological examination tests, we will observe results below what is expected. On the contrary, functionality is usually preserved. When we talk about functionality we refer to whether the person is autonomous or not to perform basic activities of daily living (showering, dressing, toileting, eating) and/or instrumental (money, shopping, medication, cooking, etc).

This is the time to consider further tests in order to reach a more accurate diagnosis in order to start a specific treatment if any. 

And Dementia...

It would be the sum of the progressive loss of cognitive functions called cognitive impairment with the loss of functionality of the patient.

In this case, in addition to a low performance in the neuropsychological examination, there is a loss of autonomy in basic and instrumental activities of daily living, the latter being the first to be affected. 

We will go deeper into cognitive impairment, dementias, behavioral alterations and treatments in another publication at a later date. 

Original source of the entry: https://www.casageriatra.com/blog



Head of the Psychogeriatrics Unit - Bermingham Hospital

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