MEMORY LOSS: CAUSES AND TREATMENT

From normal aging to a great number of disorders, memory loss could be a common finding, not only Alzheimer’s disease is the cause. Forgetting the name of a person, misplacing your glasses, everyone forgets these things. Memory loss may be part of aging, a dementia disorder, or due to a reversible cause. 

You are in the right place if you are having memory impairments to get a diagnosis and appropriate care. 

What are the causes of memory loss?

Age-related memory loss

This is a phenomenon described as normal. You might occasionally misplace your wallet. You might forget a restaurant's name but recall it later. Maybe you might need to make a list to remember tasks or appointments. Disruption in your life is normally not caused by normal age-related memory loss. All of the changes noted in your memory are somehow easy to manage and do not impact significantly your work and social activities.

Mild cognitive impairment

Memory is described as a cognitive function or a thinking skill, along with attention, orientation, judgment, and some others. 

In this condition, a decline in at least one of them is found, memory could be the one affected. The impairment in memory is greater than expected for aging but less than in dementia. Persons affected with mild cognitive decline are not affected to perform activities of daily living or be socially active.

Dementia

Although broadly used in medical and nonmedical settings, the term "dementia" does not involve a single condition. This word is an umbrella term that describes a set of impairments in memory, judgment, language, orientation, and other cognitive domains. Dementia tends to begin in a gradual manner with further worsening and is irreversible. Another important feature of dementia is the impairment in the functionality of the person in relationships, work, and social interactions. 

​Memory loss as part of dementia may disrupt life and is one of the first noticeable signs. Other signs might include:

  • Repeatedly asking the same questions. 

  • Difficulty following instructions.

  • Taking longer to plan and execute ideas.

  • Abnormal mood or behavior changes without a precipitant.

  • Getting lost in familiar environments.

Among the most common diseases that can result in dementia are:

  • Alzheimer's disease

  • Vascular dementia: This happen most common in patient with diabetes, hypertension and cigarette smokers.

  • Frontotemporal dementia: This tend to present at age 50 to 60 with abnormal behaviors such as impulsivity,

  • Lewy body dementia: This condition presents along with visual hallucinations and similar movements as the ones seen in Parkinson disease.

Reversible causes of memory loss

Different medical conditions can present memory loss or impairments in memory. The majority of them can be reversible, your neurologist will rule out this condition most of the times when you or your family member present with memory issues.. 

The different causes of reversible memory impairment include:

  • Normal-pressure hydrocephalus. A neurological condition that primarily affects older adults and can result in cognitive dysfunction and dementia. NPH occurs when excess cerebrospinal (CSF) fluid builds up in the ventricles of the brain. The etiology of NPH in most cases is widely unknown, NPH symptoms exhibit a classic triad of clinical findings including memory loss, urinary incontinence, and gait disturbance. 

  • Sleep disorders. This category includes sleep apnea, insomnia, and chronic loss of sleep. These sleep conditions lead to significant effects on cognitive functioning, including memory impairments.

  • Medications. A great number of drugs or combinations may impair memory function.

  • Traumatic brain injury or concussion. Regardless of the cause of the injury, and even without losing consciousness, the memory function could be affected.

  • Mood disorder. Depression and anxiety may impair memory function, causing confusion, difficulty with concentration, and forgetfulness.

  • Alcohol consumption. Chronic consumption can disturb several cognitive functions, including memory. 

  • Vitamin deficiency. Vitamin B1 or Vitamin B12 deficiencies regardless of their cause may impair memory and cause other neurological symptoms.

  • Hypothyroidism. A decreased thyroid activity may be manifested as forgetfulness and other cognitive impairments.

  • Brain disorders. Seizures, tumors, or infections in the brain may affect memory and the rest of the cognitive functions

How is the diagnosis of memory loss made?

 

Diagnosing the cause of memory impairment is a challenging task for your doctor. A lot of people oversee their memory problems and is possible that the family or friends compensate for the patient's difficulties, leading to unawareness of the problem.

Identification of a reversible cause of memory loss is imperative to receive the appropriate treatment. In order to diagnose the cause of memory loss the first step is to rule out reversible causes, the evaluation includes:

Diagnostic testing

  • MRI brain

  • CT head

  • EEG

  • PET

  • RBANS

  • Montreal Cognitive Assessment

  • Sleep study

Laboratory testing

  • Vitamin B12

  • Vitamin B1

  • Homocysteine

  • ESR/CRP inflammatory labs

  • TSH

  • Hemoglobin A1c

For several conditions that cause memory impairment, to mention Alzheimer’s Disease, the diagnosis is established with the evaluation of the patient history and physical examination.

What is the treatment for memory loss?

 

Life interventions

Improvement in sleep, mood, exercise, and daily mental habits has been shown to improve your cognitive function.  Medical evidence recommends focusing on lifestyle interventions to improve brain function, both for individuals with significant memory loss and those who are working to avoid neurodegeneration (a major cause of dementia) in the future.

 

Sleep

The two main conditions to consider that impair sleep includes obstructive sleep apnea and primary insomnia. 

 

Obstructive sleep apnea. This condition is characterized by loud snoring, interruption of sleep due to periods of absent breathing, and severe fatigue during the day. You can try certain changes during sleep as the following:
 

Insomnia. The recommendation for regaining normal sleep is to look toward our natural sleep routines.  Sleep is a very primitive function in our brains, and we think that training the brain to sleep is similar to training a pet not to bark or beg at the table.  The “waking” part of the brain wants to stay up all night worrying or reading interesting things, and we need to teach this part of the brain to finally give up and sleep.

 

I (and many other physicians treating sleep) recommend this type of program:


 

  • Make sleep a top priority, and don’t give up until you have figured out your particular routine necessary for restful sleep!

  • Learn a progressive relaxation (head to toes) or breathing exercise that you can use when stressed or not falling asleep easily.

  • We want to associate the bed ONLY with sleep -- not for reading, watching television, or reading interesting things on the Internet.  Everything else is done in another room or a different part of the room.

  • In another room, find a chair and light (warm, not too bright).  We recommend purchasing a large book, not too interesting.  Reading this book in this spot will be your signal to wind down to sleep.

  • Create a nightly ritual for sleep:

    • Set a time that you will target for lights out.

    • Prepare the bedroom for good sleep (dark, cool, quiet).

    • We recommend keeping the iPhone in the other room and using a standalone alarm clock.

    • Remove, cover, or put away the television, computer and other screens.

    • 45 minute before bed, turn off the TV, computer, and phone.

    • Create a wind down pattern with herbal tea, music.

    • Sit down at the chair, read for a 5-10 minutes 

  • Head to bed, do some deep breaths/progressive relaxation, and SLEEP

  • If you find yourself awake at night, don’t despair, when you’re in a relaxed state in bed, your brain is in Stage 1-2 sleep and getting many of the benefits of sleep. With time you will spend more time in deeper Stage 3 sleep.

  • If you’ve had enough of staring at the ceiling, go back into the other room and read the book for 5-15 minutes (remember we’re training the brain to finally give up and sleep).

  • Don’t expect to see major benefits for a couple of weeks, we don’t develop insomnia overnight, and it doesn’t get fixed overnight!

 

We’ve found these can make the program work better:

  • Get as close to 1 hour of physical activity and/or 10,000 steps daily

  • Limit caffeine to before 1 PM

  • Minimize alcohol to 1 drink at dinner, and not before bed

  • Taper off all sleep medications, slowly.  We recommend 10% every 2-4 weeks and always keeping the medical provider involved in this process

  • Try melatonin 1-2 mg at night

  • Try magnesium 200-400 mg at night

  • Other herbal medications can be considered, including damiana

  • Make time for a short afternoon nap if possible

 

Cognitive training

For people wanting to stave off memory loss or prevent the development of dementia, there are numerous computer-based products to purchase or to which to subscribe.  The evidence to support their use or to choose between can be confusing.  

 

Available brain training programs

 

  • Currently, Lumosity, produced by Lumos Labs, is the most extensively advertised cognitive training program with frequent over-the-air and Internet-based advertising.  A battery of online tests is used to assess and potentially support healthy cognitive functioning.  Lumosity offers video game-like training sessions that are meant to improve functioning in memory, attention, motor speed, and logical reasoning domains in a way that should influence cognitive performance in real-world situations.  

  • Similar to Lumosity, BrainHQ has been the subject of clinical trials that have shown similar significant but modest effects on standardized tests.  One study featured on the training program’ promotional materials reports findings from 487 individuals randomized to the BrainHQ program as compared to watching educational videos about cognitive performance.  A 4.1% average improvement in auditory memory and attention was noted in the BrainHQ training program, and a 1.9% improvement was noted in the group watching the videos (Smith et al., 2014).  A 58.6% improvement was noted in motor speed after the training as compared to a 6.8% improvement in the video education group, suggesting that practice effects of playing the cognitive games may lead to domain-specific improvements with testing.

·A review of cognitive training programs suggests a modest benefit overall and little evidence of change in practical outcomes (Lampit, Hallock, & Valenzuela, n.d.).  

Exercise

Physical activity and exercise have been long researched as an intervention to improve cognition. 

 

The physical activity required to achieve these effects in older adults is variable from person to person, however, it is generally thought that 30 minutes of moderate physical exertion 5/week or 20 minutes of extreme physical exertion 3/times a week is sufficient. The important thing is to target significant increases in heart rate and breathing during these periods of physical activity.

 

The general philosophy in recommending exercise to those who have been generally sedentary is to “meet them where they're at." Here are some general principles:

  • I make a target of aiming towards exercising for 20 to 40 minutes 5-7 days per week. 

  • I recommend starting with short walks and progress to longer and longer walks and hikes.  Walking on the beach is a great workout.

  • If individuals have imbalance, walking sticks can be considered to aid in maintaining balance.  https://www.rei.com/c/trekking-poles

  • Walking and exercising in the pool is a great idea for individuals with poor balance and a risk of falling.  http://www.santamonicaswimcenter.org/

  • Elderly individuals should incorporate light weightlifting to aid in maintaining muscle mass.

  • I recommend an exercise cycle for indoors exercise.

  • If a patient is not ambulatory, a foot cycle can be considered.  https://www.latimes.com/bestcovery/best-mini-exercise-bike-overall

  • Other great approaches include yoga, chair yoga, tai chi, pickleball, swimming, and cycling outdoors.

 

Hearing treatment

If you are experiencing poor hearing, it can result in functional impairment. I recommend a basic hearing screening test in the clinic for individuals with a history of poor hearing and referral to an audiologist for further testing and consideration of hearing aids.

 

Low cost hearing aids include sets offered at Costco and by Bose: 

 

Hearing amplifiers can help with improving the understanding of conversations: 

Art therapies

Art therapy has been studied through a number of small clinical trials, and improvements in mood, general well being, and memory functioning have been reported.

 

We recommend pursuing art therapy as a “brain training approach.”  It has the benefit of improving hand-eye coordination and can improve mood in many individuals experiencing anxiety or depression about their cognition and other health issues. 

 

I particularly like “sketching from life” as a simple approach that requires few tools and can be performed anywhere.

 

Such techniques can be learned through art schools: https://www.brentwoodart.org/

 

Other instruction occurs through videos https://www.youtube.com/watch?v=lz33416kapQ or books devoted to the subject, such as Drawing on the Right Side of the Brain http://amazon.com/Drawing-Right-Side-Brain-Deluxe/dp/158542921X/

 

Music therapy

Music therapy has been studied to improve cognitive functioning, and the nonverbal aspects of music including the “wide variety of multisensory experiences, including motor functions, reading of musical notation, and auditory functions” have been hypothesized to improve cognitive functioning.  Musical training has been shown to treat cognitive decline be protective against future cognitive decline.

 

Many individuals concerned about developing memory loss ask for interventions that may protect them against future cognitive decline.  We recommend considering learning a musical instrument, commonly guitar, piano, or singing, as a proven method to protect, to some degree, against future cognitive decline.

 

For individuals with significant memory loss or a diagnosis of progressive dementia, playing music, especially from one’s teenage years, can serve to calm agitation and improve mood.

Optimizing diet

The most effective diets revolve around reducing bodily inflammation and maintaining heart health (generally by reducing hypertensive risk). The regular consumption of whole grains, unsaturated fats, lean meats, and lots and lots of vegetables leads to a healthier cardiovascular system as well as a healthier mind. Additionally, a diet with a low glycemic index (such as ketogenic or low-sugar diets) profoundly reduces inflammation throughout the body.

 

Intermittent fasting periods are also very useful in reducing the risk and progression of cognitive decline. An intermittent fasting diet involves strict fasting (usually for 18 hours a day), followed by periods of normal eating (usually for 6 hours a day)

 

Recommendations:

Is there any medication for memory loss?
  • Memory loss

    • Namenda

    • Aricept

  • Insomnia

    • Melatonin

    • Magnesium

    • Mirtazapine

    • Trazodone

    • Seroquel

  • Agitation

    • Mirtazapine

    • Seroquel

    • Lamotrigine

    • Depakote

  • Weight gain

    • Remeron

    • Marinol