Why It's Smart to Ask For a Memory Test
Many of us joke about those times when we forgot why we walked into a room or had difficulty recalling a person’s name. Although such “senior moments” become more common as you enter your 50s and 60s, it’s comforting to know that this minor forgetfulness is a normal sign of aging, not a sign of dementia.
But other types of memory loss, such as forgetting appointments or becoming momentarily disoriented in a familiar place, may indicate mild cognitive impairment. So when should you take memory lapses more seriously? Probably earlier than most people—and many doctors—do, suggest two separate studies.
A predictor of future problems?
Early memory complaints from older adults at increased risk for dementia may predict cognitive decline later in life, according to a study published in 2014 in Neurology. The finding adds to a growing body of evidence that has led to similar conclusions. In this study, adults who had subjective memory complaints were almost three times more likely to develop mild cognitive impairment than were high-risk participants who had no complaints.
The term “subjective” memory complaint is used by some experts to describe when individuals notice that their own memory and thinking abilities—such as trouble remembering where they placed an item or increasing difficulty recalling names or recent events—aren’t as good as they once were. The problems typically go unnoticed by others and don’t affect day-to-day living.
Mild cognitive impairment is a memory disorder that falls somewhere between age-associated memory impairment and early dementia. People with mild cognitive impairment are more forgetful than normal for their age, but they don’t experience other cognitive problems associated with dementia, which is the most serious form of memory impairment.
In the Neurology study, the investigators reached their conclusion after evaluating 531 older adults (average age, 73) who had one or more risk factors for dementia, such as a family history of the condition, the presence of a gene associated with Alzheimer’s, high blood pressure, type 2 diabetes or a history of smoking. They also found that mild cognitive impairment or dementia developed about nine years, on average, after the initial subjective memory complaints. Moreover, some deceased participants’ brains showed signs of Alzheimer’s, even when the patients hadn’t begun to exhibit symptoms of the condition.
Based on their findings, the researchers caution that people with subjective memory complaints—and their doctors—should not minimize the problems. Still, they say, it’s important to note that this type of memory complaint isn’t necessarily a precursor to mild cognitive impairment and may simply be a result of the mild changes in memory and thinking that can come with aging. Also, even if your doctor does suggest screening, that doesn’t mean you’ll be diagnosed with mild cognitive impairment or dementia. In some individuals, underlying factors like depression, hearing or vision loss, thyroid dysfunction, certain medications, vitamin deficiencies or stress may be responsible for cognitive problems. In such cases, treating the underlying condition typically leads to improvement in memory.
Dementia often overlooked
A 2015 Neurology study revealed that a surprising number of adults with dementia have never been evaluated for the condition. The researchers evaluated 856 people ages 70 and older who took part in a larger national study on aging, demographics and memory. From that group, the researchers identified 297 individuals who met the criteria for dementia.
Less than half (44.8 percent) had previously been evaluated by a doctor for cognitive impairment—information the researchers gleaned from people close to the participants, rather than relying on each patient’s memory. Those who had been evaluated by a doctor were more than 2.5 times more likely to be married than their counterparts who hadn’t been assessed—a finding that suggests spouses may be the first to notice cognitive impairment in their partners and can be the driving force behind getting an assessment.
While it is true that interventions to slow or stop most cases of dementia don’t exist, having a diagnosis and getting available medical care may improve the quality of life of the person with the condition and ease the burden on the family caregiver. Furthermore, controlling blood pressure and other risk factors associated with vascular dementia (a type of dementia that results from blood vessel disease) can reduce the risk that the condition will get worse.
The researchers couldn’t point to one specific reason why memory tests are rarely performed in people with signs of dementia— even those who regularly visit their doctors. They suspect a combination of factors may be responsible. These include practitioners who may not recognize dementia symptoms, as well as appointment time constraints. In addition, some patients may not be willing to undergo testing; one study found that nearly 48 percent of patients over 65 who screened positive for dementia declined further testing. The researchers hypothesize that some people, especially those who are not married and live alone, may be afraid that a dementia diagnosis will force them to give up their independence.
An annual cognition checkup?
If you’re covered under Medicare, you are entitled to receive a routine cognitive screening evaluation at no cost as part of your yearly wellness visit. (Routine screening refers to periodic testing of a group of people—in this case, older adults—for a certain condition even when a person may not have signs or symptoms of that illness.)
In addition to performing your annual physical exam, your primary care doctor will assess your mental function, which typically entails observing you during your conversations together, taking into account any memory concerns expressed by you or loved ones and sometimes asking a few brief questions about your memory. Some providers may use structured questionnaires or other tools for evaluation, as well.
Interestingly, the U.S. Preventive Services Task Force (USPSTF)— an independent panel of medical experts—does not recommend routine memory tests for older adults. The USPSTF contends that currently there is insufficient scientific evidence to assess whether the benefits of routine screening outweigh the harms.
Another approach comes from the Alzheimer’s Association, which advises physicians to ask during the annual wellness visit whether a patient has been experiencing signs or symptoms of cognitive troubles. If symptoms are present or if no one is available to confirm that they are not, a brief memory test should be performed.
The bottom line
If your primary care doctor doesn’t ask whether you (or your loved one) has been experiencing memory or thinking problems, but you feel that a cognitive assessment would be helpful, by all means bring it up.
In addition to performing an initial assessment, the doctor can rule out underlying health problems that could be responsible, and, if necessary, refer you to a physician who specializes in diagnosing and treating Alzheimer’s disease and other forms of dementia.