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Older woman asks if Alzheimer's is cause of her memory lapses

Dr Melanie Wynne-Jones discusses

Dr Melanie Wynne-Jones discusses

Case history

Mrs Smith is 55 and says her memory is worrying her, particularly as her mother had Alzheimer's disease. She wants to know if she is at risk, and can she do anything to preserve her memory.

What exactly is wrong with her memory?

Most people complain of memory lapses as they get older – forgetting names or where they put the car keys. This is known as age-associated memory impairment (AAMI) or, less kindly, a 'senior moment'. Memories can usually be retrieved in AAMI but take longer to locate than previously.

However, memory lapses and difficulty in finding the right word are often early signs of Alzheimer's disease. I find that patients are increasingly worried by the thought of Alzheimer's and come to ask whether they are normal. Asking for specific examples will give you some idea whether you need to take Mrs Smith's lapses seriously, but patients often deny they have a problem, and friends or relatives can often reveal the true situation.

Dangerous behaviour, such as leaving the gas on, may indicate the need for urgent action including the involvement of mental health or social services.Conducting a 10 or 30-point mini mental state examination doesn't take long, and will tell you whether there may be a problem. If it is normal, it will help to reassure Mrs Smith that her memory is working reasonably well. You will also need to look for evidence of mental or physical illness.

What are the clinical causes of memory loss?

As well as the various dementias, (Alzheimer's, vascular and Parkinson's related for example) other mental illnesses can affect memory. People who are anxious, stressed, depressed, psychotic or have a learning disability may not be functioning well enough to register, store and recall information. Various prescribed and street drugs can have the same effect, while alcohol excess or thiamine deficiency can cause both acute and long-term memory problems (Korsakoff's syndrome).

Acute and chronic medical conditions can also affect cognitive function and memory, including hypothyroidism, diabetes, cerebral tumour and chronic heart or lung disease. Head injury, epilepsy, cardiovascular insufficiency and transient global amnesia can all temporarily affect memory as can delirium from any cause. Boredom, sleeplessness, being too busy, and poor sensory input (blindness, deafness) also make it difficult to register and lay down memories.

Many women complain that pregnancy temporarily affects their cognitive function, and some menopausal women say their memories improve if they take HRT.A thorough history, examination, investigations and even referral may be necessary if you suspect organic memory loss. Clinical psychologists can carry out detailed memory tests if indicated.

What are the risk factors for Alzheimer's disease?

Alzheimer's is the commonest form of dementia in the UK, affecting around 450,000 people and one in 20 over 65. Age is one of the greatest risk factors, and only 15,000 of the people in the UK with Alzheimer's are under 65. Severe or repeated head injury, and Down's syndrome also increase the risk, as do smoking, hypertension and hyperlipidaemia (which are also linked to vascular dementia). Other environmental factors, as yet unidentified, may contribute.

Mrs Smith's mother probably doesn't affect her own risk of developing Alzheimer's. Having two affected relatives is not unusual, and most late-onset Alzheimer's reflects environmental as well as genetic factors. There is no single gene that causes Alzheimer's and familial (early-onset Alzheimer's) is quite rare. It tends to affect family members in their 30s or 40s, and is linked to defects in chromosomes 21, 14 or 1. Counselling is available for people with at least two close relatives affected before 65. You will probably be able to reassure Mrs Smith that she is not at particular risk.

What advice can you give Mrs Smith about maintaining her memory?

If her memory seems normal for her age and she is not unwell, there is plenty she can do to slow cognitive decline.

Use it or lose it is the current buzz-phrase, and there is evidence that exercising our brains will keep them active for longer. If she doesn't have a job that stretches her mind, she could try quizzes, crosswords, learning a new skill, using a computer or other hobbies that involve reasoning or counting. You could suggest she starts using simple memory aids including a diary, making lists, and using Post-it notes. If being too busy or stressed is affecting her memory she could consider cutting down or learning relaxation techniques.

The usual healthy lifestyle advice will also help to preserve brain circulation – including keeping blood pressure and cholesterol levels low and taking regular physical exercise. Omega-3 fatty acids found in oily fish, nuts and seeds may also help. 'Superfoods' containing antioxidants are often recommended – such as tea, dark-coloured fruit and vegetables, red wine and chocolate containing more than 70% cocoa solids. If she cycles, she should wear a helmet to avoid head injury. Taking aspirin in the absence of other indications has not been shown to improve cognitive function in women over 65.

Dr Melanie Wynne-Jones is a GP trainer in Marple, Cheshire

Key points

  • Age-associated memory impairment (AAMI) is a common experience
  • Anyone complaining of unusual memory loss should be thoroughly evaluated for mental or physical ill-health
  • Early-onset dementia can be inherited; most cases of Alzheimer's disease are multifactorial
  • Patients should be given information on how to look after their brains

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