Memory loss and cognitive impairment of the elderly

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Memory loss and cognitive impairment of the elderly

Memory loss and cognitive impairment of the elderly

These symptoms are often a precursor to Alzheimer disease ADbut sometimes dementia does not occur, even after many years of observation.

There is currently no reliable way to distinguish between these 2 possible outcomes in an individual patient. We hypothesized that clear impairments in at least 1 cognitive domain in addition to memory would help identify those who will progress to AD. Age-adjusted normative criteria were used to identify whether additional impairments were present in language, attention, motor visuospatial function, and verbal fluency at this initial evaluation.

Outcomes were adjusted for age, intelligence at initial evaluation, and years of education. Deficits in block design were the most frequent abnormality other than memory loss.

However, the risk of dementia is significantly increased among patients with clear cognitive impairments beyond memory loss.

Further study is needed to determine whether patients with impairments limited to memory loss have a distinctive clinical course or pathophysiology. For individuals with memory impairment but preserved general intellect and activities of daily living, prognosis is uncertain.

In some cases, this pattern of cognitive deficits may indicate the earliest symptoms of dementia. Others will have a more benign course. Different criteria have been used to define the features that may predict progression to dementia.

In particular, researchers have focused on declines in episodic memory, since this cognitive system is known to be affected earliest and most profoundly by Alzheimer disease AD. It was believed that this classification, isolated memory impairment IMIwould represent, in effect, a possible pre-AD state.

Corroborating this designation, the positron emission tomographic PET scans of a group with IMI demonstrated a pattern of hypometabolism more closely resembling that of AD patients than that of a healthy elderly control group. There is also evidence from PET studies that functional changes in AD affect widespread areas of cortex, not just the limbic system, even in what appears to be predementia states.

For this study, we hypothesized that among nondemented patients with memory complaints, measurable impairments of at least 1 cognitive domain in addition to memory could help identify those who would progress to AD over a few years.

Subjects and methods Selection of subjects Of subjects in the Michigan Alzheimer's Disease Research Center MADRC database who were diagnosed as having IMI by a subspecialty-trained neurologist on at least 1 clinic visit, we identified 53 patients who had been evaluated for memory disturbance, met criteria for IMI at their initial evaluation, and had repeated evaluations during at least a 2-year period.

The diagnosis of IMI is based on both clinical and psychometric evidence, delineated below. These patients were excluded, leaving 48 subjects. Clinical evidence of IMI was based on the following: Standard laboratory blood tests and structural brain imaging computed tomography or magnetic resonance imaging were performed as part of this evaluation.

Thus, we identified memory impairment as significant when subjects had an immediate recall score of 6 or less on the Benton Visual Retention Test—Revised or when the sum of scores on immediate recall of logical memory I LM-I and paired associates PA subtests on the Wechsler Memory Scale were 19 or less.

In addition, to address concerns regarding the validity of these historical AAMI criteria, we compared each subject's scores on LM-I and PA to age- and education-adjusted cutoffs. Neuropsychological and neurological evaluations A neuropsychologist B.

We used age-adjusted normative criteria to identify the presence or absence of impairment in the following areas: If the Controlled Oral Word Association Test was unavailable, letter fluency on the letter d was substituted. The clinical outcome for each patient at 2 years and at the most recent neurological examination was determined by a neurologist A.

The designation of AD or continued memory impairment without dementia was based on documentation of impaired instrumental activities of daily living caused by cognitive impairment in the medical record by the patient's treating neurologist.

In some cases, repeated neuropsychological testing was available to the treating physician; however, outcome in this study was based on the physician's clinical judgment.

The choice of a clinical outcome measure simulates typical clinical decision making, given that follow-up neuropsychological data are frequently not obtained by treating clinicians.

As an additional check on the treating physician's initial determination of IMI, we had an assistant who was certified by the Alzheimer's Disease Cooperative Study obtain a chart review—based Clinical Dementia Rating CDR score for each subject's initial diagnostic clinic visit.

Since the CDR score takes into account only information from the history and physical sections of the visit note, we hoped to address concerns of possible bias on the part of the treating physician who made a determination in conjunction with neuropsychological testing in some cases.

Logistic regression was used to compare outcomes in the 2 groups at 2 years, adjusted for other prognostic factors. Kaplan-Meier curves were compared using the log-rank Mantel-Cox test.The primary difference between age-related memory loss and dementia is that the former isn’t disabling.

The memory lapses have little impact on your daily performance and ability to do what you want to do. Symptoms of mild cognitive impairment (MCI) Mild cognitive impairment (MCI) is an intermediate stage between normal age-related.

Many American families care for an adult with a cognitive (brain) impairment. Cognitively-impaired people have difficulty with one or more of the basic functions of their brain, such as perception, memory, concentration, and reasoning skills.

Excessive alcohol use has long been recognized as a cause of memory loss. Smoking harms memory by reducing the amount of oxygen that gets to What Is Sluggish Cognitive Tempo? Stroke Explained. Mild cognitive impairment (MCI) causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills.

A person with MCI is at an increased risk of developing Alzheimer's or another dementia. Mild cognitive impairment causes cognitive changes that are. Mild cognitive impairment (MCI) is the intermediate stage between the cognitive changes of normal aging and dementia. Individuals with MCI show cognitive impairment greater than expected for their age, but otherwise are functioning independently and do not meet the criteria for dementia.

MCI is. In cognitive impairment 5% elderly had mild cognitive impairment, % elderly had moderate cognitive impairment, and % elderly had severe cognitive impairment. There is a significant association between age and memory is no significant association between cognitive impairment with demographic variables.

Mild Cognitive Impairment in Older Adults