Memory is described as storing, preserving and recalling of information and it is classified into short-term and long-term memory. On getting hold of information, it is immediately stored in the short-term memory. Shortly, this data is conveyed to long-term memory, which is lasting.
Short-term memory is a collection of nerve impulses and is very vulnerable to impairment (Rabins, 2007). In this case, a condition known as dementia occurs where patients can recall events that happened in the past but they can barely recall immediate things like the person they have just met. Many studies have been conducted to show the causes of memory loss and its management strategies. Serious memory impairments are often associated with aging and disease.
Age Associated Memory Impairment (AAMI) is common where elderly persons are unable to remember information or new facts. On aging, memory efficiency declines and memory lapses occur although in most cases it is mild and does not affect the day to day life of an individual. Memory loss in aging could be total or partial and it is often expected.
However, in case of a disease such the Alzheimer’s disease, there is pervasive memory impairment to the extent that relationships and social activities are compromised. In case of Alzheimer’s disease, memory loss is mostly lasting and happens steadily. In addition, recurrent diseases such as epilepsy and meningitis are also attributed to permanent and sudden memory loss (Rabins, 2007). This paper shall discuss memory impairment associated with diseases and aging while covering various case studies to assert the claims.
Mild Cognitive Impairment (MCI)
When a person’s memory goes below the normal state, this is assessed through determining MCI. In MCI, evaluation is based on the results of memory tests. It is however, a less serious condition than Alzheimer’s disease where an individual has inability to perform tasks or becomes disoriented and confused.
As MCI progresses, there is a decline in mental functioning capabilities. Individuals in such a state have extreme memory lapses abnormal to their age. MCI is indicated through forgetting names as well as places familiar to them, fail to service appointments and make repetitive jokes.
This means that diagnoses of MCI should be carried out immediately the memory impairment is noticed as a destructing factor of day to day activities. Studies have indicated that elderly individuals with MCI have a high likelihood of acquiring Alzheimer’s disease as time goes by. Thus on noticing such instances patients are recommended to take vitamin E and Alzheimer’s disease medication since they could prevent and postponement Alzheimer’s disease in individuals with MCI (Chertkow, 2009).
A study of five years in Mayo Clinic of patients with MCI and who are undergoing medical attention in the department of Internal Medicine was done. Patients were diagnosed for MCI, when complaining of defective memory, when this interfered with their day to day activities, had normal cognitive performance, impaired memory according to age and lack of dementia. As a result, out of over seventy five patients, about 10-15 % of the cases turn to be AD every year.
Analyzing their cognitive profiles since their first diagnoses to evaluate the ones whose condition was stable and those whose condition would turn to AD was essential. Following this, learning as well as memory function showed a probability to turn to AD and also depended on the condition of apolipoprotein E (Petersen et al, 2005).
The ones possessing ?4 allele had a higher chance to progress to AD at a faster rate as compared to those who lacked it. From this study, it is clear that diagnostic method could be specified for patients whose likelihood to progress to AD is high. Their family history is a crucial aspect and therefore, aiding in prediction of those patients who would progress to AD. Patients with MCI were very helpful in this study especially through the therapeutic interventions carried out (Petersen et al 2005).
From another case study conducted by Chertow et al on diagnosis and treatment of MCI, published by American Psychiatric Journal, it is necessary for family doctors to be conversant with the fact that diversified dementia forms are occur after a significant phase of mild cognitive impairment.
Such patients should be well monitored, since they have elevated risk of having dementia. They should also be put under leisure, bodily exercises as well as cognitive stimulation and other constructive daily life habits. MCI patients should be evaluated and treated for vascular risk factors.
From the study, “a 10-year follow-up study in a memory clinic, Visser and colleagues found the risk of progression to dementia to be 48% among 64 patients with mild cognitive impairment. In a Canadian study involving 89 patients with mild cognitive impairment recruited in a memory clinic, no disease progression occurred in about 25%, even 10 years after onset of memory problems” (Chertow et al, 2009).
Age Associated Memory Impairment (AAMI)
AAMI is marked by mild symptoms of a low cognitive ability, which is common during aging. These include decreased ability to process, store and recall facts. In addition, there is a decreased ability to undertake roles connected to cognitive functioning like memory, decreased concentration and inability to organize tasks (Barker et al 1995).
AAMI patients reports having a hard time in recalling names or certain words. AAMI has been attributed to physiological changes that occur in the aging process of the brain, which interferes with its functioning rather than a neurological impairment.
The brain has many neurons which continue to shrink with age and may affect mental functioning. As a result, neurotransmitters production becomes low. Cultural attitudes that ageing leads to inevitable memory loss may cause memory lapses in elderly where expectation worsens the situation. In addition, elderly people may not give keen attention to new facts thus their loss of interest and alertness may be taken to be memory lapses (Rabins, 2007).
Symptoms and Diagnosis
AAMI I is affirmed when the degree of cognitive power is low as compared to the prior functioning. A psychometric testing is done to determine the cognitive performance, and is compared with the patient’s age. If it is within the limits, cognitive decline is not attributed to destruction of daily activities.
Diagnostic assessment for AAMI involves neurological evaluation, mental status assessments, neurophysiologic as well as psychiatric exams (Rabins, 2007). Physical exams can be performed, which include laboratory procedures and assessment of the medical history of an individual as well as the medications that the person has been using. Following these procedures, clinical observations are carried out on indications, onset and appearance and development of the signs (Chertkow, 2009).
AAMI symptoms are gradual due to normal aging occurrence and permanency may occur as age progresses although it is within certain limits of functioning with regard to the age group. AAMI results from normal biological alterations during aging although it has not been ascertained of the role of environment and heredity associated with AAMI (Barker et al, 1995). Forgetiveness caused by AAMI is an aspect that patients must cope with.
Treatments for AAMI are unavailable for managing the symptoms although memory management plans can help the patient deal with the problem. Patients are recommended to have future plans of accessing health care attention (Rabins, 2007). These could be indicated in writing healthcare proxies, considering living wills among other future plans. Symptoms of AAMI may trigger anxiety on fearing the onset of Alzheimer’s disease or even severe memory destruction.
Therefore, medical assessments are crucial to be certain of the problem and reduce anxiety by having the actual information of whether the symptoms are medically related to another issue. AAMI is not a good experience since it disrupts a person’s normal schedule and reduces productivity and the standard of living. To manage the condition, patients should not misplace important items like eyeglasses and keys and should have a record of appointments or phone numbers in written notes in a clear area to reinforce memory.
Besides, patients could loudly assert phrases after an action or may have the newer facts being stated in the conversations. Memory and visual aids like alarm are essential to reinforce memory. Paying attention and applying mnemonics like acronyms and acrostics could help to jog the mind and help to remember events (Rabins, 2007).
Case Studies on AAMI
A study conducted on determining the prevalence of AAMI published in the Journal of Neurology, Neurosurgery &Psychiatry, was aimed at achieving the actual figures of AAMI, AD, and dementia in a rural population of Spain. AAMI in rural areas is prevalent in uregano, where 1011 persons from Segovia, Spain were evaluated from door to door for those past forty and sixty five years of age.
Suspected incidences of for dementia as well as cognitive impairment were succeeded by conducting a clinical assessment (Coria et al 1994). From the study, 3.6% of persons 40 year individuals had AAMI while 7.1 % of those over sixty five years had AAMI while dementia cases reported 2.6 & 5.2 % respectively.
This indicates that the prevalence of AAMI and dementia increased as age progressed. In the dementia, the form that had a high incidence was AD, which had 1.8 & 3.8 % respectively. Vascular dementia had an occurrence of 0.4 & 0.9 % while secondary dementia had 0.4 & 0.5 % respectively. AAMI is dependent on age as indicated; it is highly prevalent in old persons. The patients could exhibit onset of AD which shows that the disease could be more prevalent than it is predicted (Coria et al 1994).
From another study conducted by the Research Institute for the Care of the Elderly (RICE) on AAMI on a population of fifty to ninety five old patients in a health center, the “Prevalence rates for the total population and for the over-50s were estimated to be 5.8% and 18.5%, respectively” (Barker et al, 1995). The method used to conduct this study was through questionnaire, cognitive assessment and carrying out a psychiatric examination (Barker et al, 1995).
Alzheimer’s disease (AD)
Dementia is defined as interference with cognition. AD comprises 50% of various forms of dementia and its notable in patients aged over 65 years. It is attributed to neuropathlogical modifications in hippocampus as well as entorhinal cortex. Genetic abnormality on chromosome 1, 14 & 21genes is attributed to its occurrence in young patients or what is called, the early onset AD (Myers, 2006).
Late onset AD is also connected to genetic abnormality of chromosome 19, responsible for transferring cholesterol in blood and also in nerves recovery from damage. Such genetic predisposition and interaction with environmental factors e.g. brain injury, viral diseases, and intoxication, causes varied forms of AD.
It results to progressive memory changes as well as reduced alertness, orientation, language and calculation skills. It is a progressive decline in functional capability. Cognitive deficits are more evident as the condition worsens, causing remote memory damage, space or time incomprehension, as well as language problems. The failed neurons hinder communication in the brain in patients with AD (Myers, 2006).
Neurotransmitters, which enhance communication in brain cells are low in Alzheimer’s disease and may have these cells coated with beta-amyloid proteins such as amyloid plagues as well as neurofibrillary tangles to prevent good communication (Myers, 2006). This shrinks the neurons where they get impaired and die.
Memory impairment in AD is due to cell death along basal forebrain in charge for secreting a neurotransmitter called acetylcholine responsible for accelerating learning. A medical exam may reveal these abnormalities only possible in autopsy. However, behavioral symptoms can help diagnose the condition when other forms of dementia are out of question. Its treatment involves drugs like cholinergic ego tacrine, donepezil, rivastigmine and galantamine (Myers, 2006).
Individuals with Alzheimer’s disease portray memory impairment prior to diagnosis and death of brain cells. Therefore, this makes it difficult to determine if the memory loss is normal due to aging or whether it is the onset of Alzheimer’s disease. From studies, it is noted that before the death of the nerves, there is a protein substance that is responsible for memory impairment (Rabins, 2007).
Case Studies of AD
Currently, there are various studies that are being conducted to determine development of AD and the risk factors surrounding it. These patients have been identified and follow-ups made using various medical tests. From a recent study, the Karolinska Institutet in Sweden determined the occurrence of Alzheimer’s disease.
The research exposed a patient’s brain with AD, which showed amyloids under a PET scanner in the course of ED and after the patient dies (Karolinska Instutet 2010). A PET scan was conducted on a live patient with the amyloid plaque in two thousand and two on a fifty six year old AD patient. Afterwards, a follow-up PET scan as well as memory tests on the patient with AD progression was noted.
On the death of the person, a neurochemical as well as a pathological evaluation regarding the brain tissue was conducted. This helped to discover the course of AD and the study revealed amyloid plaques accumulated at an early stage when the person had only less memory loss. These levels were the same as the disease progressed and as brain energy metabolism declined thus, further damaging the brain (Karolinska Instutet 2010)
Furthermore, as more plaque accumulated, the neuronal nicotinic receptors declined, which are essential for memory performance when the disease is on early stages. In addition, there were inflammatory changes causing neuro-inflammation which could be a new causative factor of AD since it occurred at a special stage in relation to amyloid. PET technology is being applied on more than a thousand AD patients to determine amyloid accumulation.
On having positive ED results, the biomarker used is PIB-PET as a directive from American Alzheimer’s Association. From the study, it is clear that “new, modern imaging technology known as molecular imaging makes it possible to discover the disease at an early stage. This opens up new opportunities for early diagnosis and for understanding the causes of the disease and identifying patients who can be expected to respond well to future Alzheimer’s therapy” (Karolinska Instutet 2010).
Memory impairment is evidenced well in schizophrenic patients. It is however not clear on the course of the disease in relation to memory loss. The effect of medication or time span of the condition is not clear in Schizophrenia. In a separate study, a meta-analysis conducted on seventy studies by Aleman et al (1999) on ‘memory impairment in Schizophrenia’ published by the American Journal of Psychiatry indicated that there is a “significant and stable association between schizophrenia and memory impairment.
The composite effect size for recall performance was large. Recognition showed less, but still significant, impairment. The magnitude of memory impairment was not affected by age, medication, duration of illness, patient status, severity of psychopathology, or positive symptoms. Negative symptoms showed a small but significant relation with memory impairment” (Aleman et al, 1999).
General symptoms of memory loss
They vary from an individual to another depending on the causative factors but in most cases, there is a decline in alertness, being forgetful and confusion especially for the elderly. In some extreme cases, patients may experience language problems while conversing or identify an object. In such a case patients have inability to make choices or decisions and medical attention should be sought.
The symptoms exhibited by an individual are the determining factor of whether a person is suffering from memory loss. For diagnosis, a psychiatrist enquires for an individual’s medical history. Following to that, the patient is put under neuropsychological examination aimed at evaluating the patient’s memory functions. The patient may also be put under such tests as MRI, CT scan and electroencephalography for precise diagnoses (Rabins, 2007).
Management Strategies and Recommendations for General Memory Loss
In conclusion, healthy eating habits and stress reduction are preventive measures of memory loss. Risk factors such as alcoholism should be avoided. Most importantly, health conditions such as hypertension should be managed through physical exercises and lifestyle adjustment since uncontrolled blood pressure may cause stroke, hence memory loss (Rabins, 2007). All the same, sudden memory loss cannot be foreseen and therefore prevented.
Memory loss due to aging may be managed by individual maintaining healthy brain cells through dietary supplements and healthy eating, intake of much water, enough sleep and avoiding stressing situations for a better performance of brain cells. In addition, individuals who have experienced memory loss may socialize more so as to exercise their brain function.
Dietary supplements to prevent occurrence of memory loss could be mineral complexes as well as multivitamins to maintain vigorous and healthy brain cells. Garlic for example is essential for memory loss as a result of aging since it has been used as a brain cell guard (Rabins, 2007). Minerals and multivitamins give important nutrients for the body to excrete free radicals. Lecithin and boron for instance are essential minerals in improving the functional brain cells.
Gingko as well as vitamin C is essential to provide bioflavonoid for enhancing circulation of blood to the brain hence, healthy brain cells. It is recommendable that patients with memory loss keep a detailed record of and avoid misplacing essential items for easy access. Additionally, these patients could jog their minds with puzzle games, which stimulate their brain hence down regulating memory loss.
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Coria, F. et al. (1993). “Prevalence of Age- Associated Memory Impairment and Dementia .in Rural Community.” Journal of Neurology, Neurosurgery &Psychiatry, 56 (9), 973
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