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Primary care providers may be able to determine the cause of memory loss.
In straightforward cases, a primary care provider may be able to diagnose your memory problems. The essential elements of any memory evaluation include a review of the symptoms, bloodwork, pencil and paper tests of thinking and memory, and a brain scan. The doctor will typically begin by reviewing whether there are any difficulties with thinking, memory, language, behavior, incontinence, or walking, in addition to other relevant problems. Medications are reviewed as well, to make sure none are impairing memory. The laboratory studies of the blood should include basic tests to make sure there are no signs of infections or problems in blood chemistry, in addition to special tests to rule out vitamin deficiencies and thyroid problems. Pencil and paper tests of cognitive function are essential, as different patterns of performance can suggest different disorders. In the primary care setting, brief screening tests of cognitive function such as the Montreal Cognitive Assessment (MoCA) may be used.
The basic brain imaging scans are Magnetic Resonance Imaging, more commonly known as MRI, and Computed Tomography, more commonly known as CT or “cat” scans. MRIs use a powerful magnet to look at the brain. MRIs provide better pictures than CT scans, which use X-rays, but either test will show whether there is anything wrong with the structure of the brain. An MRI or CT scan can detect brain disorders such as strokes, bleeds, tumors, fluid collections, multiple sclerosis, some infections, and many other disorders. You can also see patterns of brain atrophy (shrinkage) that may be common in one or another brain disease. However, patterns of brain atrophy are just one piece of evidence that can be evaluated when the doctor is making a diagnosis. You cannot usually know for sure that someone does or does not have a particular brain disease just by looking at a brain imaging scan.
Screening tests may not be accurate for someone who is highly educated, is very bright, has a learning disability, or has a different cultural background.
Because we need to take intelligence as well as other factors such as someone’s culture, occupation, and any prior learning disabilities into account when interpreting tests of thinking and memory, screening tests that can be performed quickly in a primary care setting are not the right test for everyone. Sometimes the screening test will suggest that a memory disorder is present when, in actuality, the problem is a life-long learning disability or another factor. Screening tests can also miss small but very real signs of memory loss in someone with particularly high baseline thinking and memory function. In these cases, it is best to see a neuropsychologist or other memory specialist.
Neuropsychologists evaluate thinking, memory, and behavior.
Neuropsychologists are psychologists who have received advanced training in the use and interpretation of pencil and paper tests and questionnaires to help diagnose brain disorders. Neuropsychological evaluations factor in how many years of education someone has, their age, cultural differences, prior learning disabilities, current or prior psychiatric disorders, and other factors that could impact an individual’s ability to perform on tests of thinking and memory. For most tests, instead of a simple “passing” or “failing” score, results are compared to those of other people who are the same age and have a similar background. So, the same test result could be normal for an 80-year-old but could represent a problem for someone age 50. Once they better understand the relative strengths and weaknesses of someone’s thinking and memory, neuropsychologists also make specific recommendations of things that people can do to improve their function in daily life.
Neurologists diagnose and treat brain disorders.
Neurologists are medical doctors who specialize in the diagnosis and treatment of disorders of the brain and other parts of the nervous system. When evaluating a patient for a memory disorder, they are on the lookout for anything that could be interfering with memory as they are going through a person’s medical history, current medications, personal habits, lifestyle factors, family history, physical and neurological exam, blood work, and brain imaging studies. Note that although a straightforward memory evaluation does not require a neurologist or other specialist, if the evaluation is complicated, or if a routine evaluation does not yield an answer, seeing a neuropsychologist, neurologist, or other memory specialist can be helpful.
In addition to conducting the usual parts of a physical examination that most physicians do, a neurologist performs a specialized neurological exam to look for any problems with the brain or nervous system. This exam looks for problems such as strokes, tumors, Parkinson’s disease, tremors, multiple sclerosis, and many other disorders that could cause thinking and memory problems. Vision and hearing are always evaluated because if one cannot see or hear well, it won’t be possible to process, understand, and remember information coming in through the eyes and ears, as we will discuss below.
Not all neurologists specialize in memory disorders, so if your loved one is going to see a neurologist for their dementia, make sure they have been trained in or have experience with memory disorders. Psychiatrists and geriatricians are also physicians who may be trained in dementia; they may be the best specialist to see in your community.
© Andrew E. Budson, MD, 2019, all rights reserved.
References
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.
