Concerns about memory loss are common as we age. There’s always a fear that any slip of the memory could be the start of Alzheimer’s or another form of dementia.

You may have noticed that a parent or other loved one seems more confused recently. Or you may have noticed that they are repeating themselves or no longer able to do things that were never a problem in the past. The technical term for this is “cognitive impairment.” It can come on gradually or suddenly. It can be temporary or permanent. And it may or may not slowly get worse.

Know that your concerns are common. And they can easily lead to questions such as:

• What’s happening?
• Is memory loss related to normal aging or something more significant?
• Can it be treated or reversed?
• What can we do about this?
• Could it be Alzheimer’s? Or some other form of dementia?

If you are concerned about memory loss or cognitive impairment, you should visit a doctor for a complete evaluation.

It’s important to realize that when families are concerned about cognitive impairment issues, there are often underlying health issues that can be directly related to other medical issues.

The good news is that they can are often easily treatable and possibly completely curable. That’s why they need to be detected and treated as soon as possible. And why you need to seek help from a health professional.

Keep in mind that cognitive impairment, like many problems in older adults, is often considered “multifactorial.” That means that it may be due to more than one cause.

In this article, we’ll first share the 10 most common causes of cognitive impairment in seniors. Then, we’ll share the 10 things the physician should look for during an examination for cognitive impairment. This way, you’ll know what to expect from your visit with the physician and what questions you may be asked.

Common causes of cognitive impairment in seniors

What may appear to be significant memory loss may the result of any of the following (either individually or in combination):

1. Side Effects of Medication. Many prescription medications and over-the-counter drugs can cause memory problems either independently or in combination. This is particularly common in older adults as they metabolize medication differently and are more likely to suffer adverse effects.

One study linked more than 100 common medications (pharmaceutically classified as anticholinergics) to memory loss and dementia in older adults. Another study found that taking these same medications for as little as 60 days can alter brain function.

Anticholinergics include such common medications as:

• Sleeping pills
• Antihistamines
• Blood pressure medication
• Arthritis medication
• Muscle relaxants
• Over-the-counter sleeping aids
• Drugs for urinary incontinence and gastrointestinal discomfort
• Antidepressants
• Anti-anxiety medications
• Painkillers

Be aware that recent studies indicate that taking some statins for your heart or taking too many medications can cause memory issues as well.

If you have concerns, it is advised you talk with your doctor and make him or her aware of all of the medications you are taking.

Do NOT stop taking any medications without your physician’s knowledge and consent.

2. Dehydration. Severe dehydration, which is particularly common in older adults, can easily cause confusion, drowsiness, memory loss and other symptoms that look like dementia. This is particularly the case if you are taking diuretics or laxatives or suffer from diabetes, high blood sugar or diarrhea.

Fortunately, this memory loss is easily reversed by keeping well-hydrated with 6-8 drinks per day. And remember, drinking more alcohol is not a solution as that can cause dehydration, as well (see below).

Dehydration can also lead to urinary trace infections (UTI’s) that can cause delirium—which is caused by any infection outside the brain.

3. Alcohol Abuse. It’s no secret that alcohol abuse can lead to memory loss—whether short term (not being able to remember what you did at that party last night) or longer term. That’s because excessive alcohol use is highly toxic to brain cells, which can increase the risk of dementia.

In a related manner, excess alcohol consumption can also cause dehydration (see above) and result in a poor diet, which can affect the levels of Vitamin B1 and B12 (see below).

That isn’t to say one needs to quit alcohol completely. To play it safe, however, daily intake should be limited to just 1-2 drinks.

4. Vitamin B1 and B12 Deficiency. Vitamins B1 and B12 are vital to health brain functioning. This is particularly true for older adults, as their bodies have a much slower absorption rate of these important vitamins. This is particularly true if you smoke or drink.

A lack of B1 can lead to Korsakoff syndrome, which is a form of dementia. However, this can be reversed by supplementing your diet with additional fish, pork, nuts and seeds.

A lack of B12, can cause a condition called pernicious anemia, which can result in memory loss, slowness, confusion, irritability, apathy, fatigue and shortness of breath. This deficiency can be reversed with a monthly injection.

5. Thyroid Problems. The thyroid gland controls the metabolism. And, if one’s metabolism is too fast, they may feel confused. If it’s too slow, they can feel sluggish or depressed. Either way, thyroid issues can cause memory problems and difficulty concentrating. However, any thyroid condition is completely treatable with regular medication.

6. Depression. If your loved one is less social than they used to be, recently experienced a major loss or experienced a major life change, they’re at risk for depression. Whether through counseling or medication, however, depression can be treated. And the symptoms of memory loss can be reversed. For more information see Seniors and Depression.

7. Anxiety or Stress. Have your parent or spouse been particularly worried about something? Then their mind is preoccupied. And if their mind is preoccupied, they’ll also struggle to retain memories. What’s more, stress raises the level of cortisol in the brain, which can slow the development of the health brain connections needed to form new memories. If you think this is the case, there is a host of therapies and medications which can help.

8. Lack of Sleep or Insomnia. If your loved one doesn’t get enough sleep, their brain can’t store the facts and events that happened to them. That’s no secret to anyone who’s ever pulled an “all-nighter” cramming for a test. And insomnia, or chronic lack of sleep, only compounds the problem.

If you feel that lack of sleep is an ongoing problem, it would be wise to consult a physician to find the underlying cause—which could be as easily remedied as reducing anxiety, modifying their diet or changing a medication.

9. Anesthesia. Sometimes, the general anesthetic used in surgery can have a lingering effect. Known as post-operative cognitive decline (POCD), it is generally short-lived but can last up to a few months or even longer for some people.

Should you or a loved one be contemplating surgery, it’s recommended that physicians, family members and caregivers pay particular attention to memory function after surgery to monitor for this condition.

10. Head Injury. Any blow to the head can potentially affect your brain and memory, as well. This is in addition to the possibility of a concussion or blood clot. As a result, it’s always advisable to see a physician as soon as possible after such an injury. If needed, proper medication (and possibly surgery) can repair any damage, allowing recovery from any memory loss. If an injury (or repeated injuries) is severe enough, it can result in a Traumatic Brain Injury (TBI) or Chronic Traumatic Encephalopathy (CTE) (see below)

Now that we’ve covered the 10 most common causes of cognitive impairment in seniors, here are the 10 things your doctor should review as part of any initial evaluation for cognitive impairment. If you have any questions or comments about the causes of cognitive impairment, please post them below.

10 Things a Doctor Should Review at Your Appointment

If you’re concerned about any possible cognitive impairment in a loved one, there are 10 specific things their physician should review. As with any of these items, it’s important for the physician to discuss any of these items with both the patient and any family members that are involved. If you’re concerned about cognitive impairment, this is especially true, as the patient may not provide accurate answers.

The items a physician should address include:

1. The patient’s concerns about any issues with their memory or ability to think clearly.

If there are any concerns about cognitive impairment, this is where the physician should start.

While many older adults may deny having any challenges or not wish to discuss it, this is also important to note—especially if you or other family members have already expressed their concerns.

If the patient does wish to openly discuss the issue, it needs to be explored in greater detail. “When did you first notice any problems?” “Do you think it’s getting worse?” “If so, how quickly do you think it’s progressing?” These are all questions that need to be asked.

2. Your own concerns about their challenges.

While your loved one may be unaware of any cognitive impairment or hesitant to discuss it, this doesn’t mean that you should remain silent.

You can help facilitate the process by bringing in a written summary of what you’ve noticed. This should include information on when any problems started and whether they appear to be getting worse.

If any other family members or caregivers have concerns and are not able to attend the appointment, they should note their observations in advance to be taken to the physician for review.

3. Any challenges with instrumental activities of daily living (IADLs) or activities of daily living (ADLs).

The basic tasks which anyone accomplishes as part of their daily routine are called instrumental activities of daily living or IADLs. That’s why it’s important to discuss any challenges with:

• Driving or accessing any other form or transportation
• Maintaining their home
• Managing their finances
• Managing their medications
• Opening and responding to mail, their ability to use the telephone or other means of communication
• Shopping for groceries or meal preparation

There should also be open, honest discuss about their activities of daily living (ADLs). These are the most basic tasks associated with self-care. They are generally recognized as:

• Walking
• Feeding oneself
• Dressing and grooming
• Toileting
• Bathing
• Transferring

Any changes in their abilities with either IADLs or ADLs is important to record. That’s because they offer a clear indication of how severe any cognitive impairment may be and what further steps may need to be taken to support them while their challenges are being evaluated further.

If they are having challenges with their finances, it may be important to assign a financial power of attorney or see that one is appointed. If there are issues with mobility, it may be wise to review their home for any possible trip or fall hazards as well as accessibility.

4. The possibility of other psychological or behavioral issues that may lead to cognitive impairment.

Any cognitive impairment, dementia or delirium may be the result of a single issue or a number of them in combination (as noted above). That’s why it’s important to review the possibility of:

• Hallucinations
• Delusions
• Any changes in their personality
• Apathy
• Depression
• Anxiety
• Suddenly getting lost in familiar surroundings
• Loss of ability with visual-spatial tasks (pouring a cup of coffee, dialing a telephone)

5. The possibility of substance abuse or withdrawal

Substance abuse isn’t just associated with youth. Remember, any senior was once young, as well. They may still be dealing with those challenges or they may have developed them due to anxiety, depression or other issues.

Withdrawal poses its own unique challenges as suddenly stopping or reducing the use of alcohol or other substance may cause or even worsen cognitive function.

6. Any visible changes in their physical health.

If there are any changes to their physical health such as challenges related to balance, walking, speech or coordination, this could be related to changes in their neurological functions. The physician should also investigate any tremors or stiffness as these are often associated with Parkinson’s disease.

7. Any unnoticed change in their physical health

While a change in their gait or balance, may be readily apparent, basic challenges to their health can often go unnoticed. At the very least, a physician should check their blood pressure and pulse, do a basic blood test to analyze what isn’t readily apparent.

This can help the physician to:

• Evaluate how well organs—such as the kidneys, liver, thyroid, and heart—are functioning
• Diagnose diseases and conditions such as cancer, HIV/AIDS, diabetes, anemia (uh-NEE-me-eh), and coronary heart disease
• Determine if there are any other risk factors for heart disease
• Determine whether any medication the patient is taking is actually working
• Assess how well their blood is clotting

Basic blood tests the physician may wish to consider include:

• A complete metabolic panel, which assesses electrolytes, kidney function, and liver function tests
• Thyroid function tests
• Vitamin B12

Depending on the person’s past medical history, current symptoms, and risk factors, additional tests may also be ordered,

8. A thorough review of their current medications and dosages

While a physician can do this, it may also be of value to have a pharmacist review all of the medications in comparison with each other, as well. If your loved one is receiving medication from more than one pharmacy (possibly even by mail), it is important that a detailed listing and dosages is presented.

There are many medications are known to affect cognitive abilities on their own. In combination with one or more other medications (which, on their own could be harmless), there could be a noticeable worsening in cognition.

Some of the most common medications to question fall under the categories of:

• Benzodiazepines. These are prescribed for anxiety or insomnia and include such drugs as: lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
• Prescription sleeping aids, such as zolpidem (brand name Ambien)
• Anticholinergics. This can include drugs for overactive bladder, sedating antihistamines, most over-the-counter sleeping aids, muscle relaxants, and others.

9. Their orientation and thinking abilities

By orientation, we mean their ability to correctly state where they are, what day of the week it is, or even what year it is. If you’re visiting with the physician due to challenges with cognition, prepare to be surprised. An individual can appear to function perfectly normally in many instances, watch the news and still have no idea what year it is or who the current President is.

A simple test of their thinking abilities is called the “Mini-Cog.” Comprised of a short three-tem recall and the ability to draw the face of a clock, it has been shown to be highly effective in assessing cognitive abilities.

Another more detailed test (which might involve a separate visit) is the Montreal Cognitive Assessment Test (MOCA). This takes 10-20 minutes to administer so may not be possible with any initial visit.

10. Additional testing, such as brain imaging

In addition to blood test, the physician might also suggest brain imaging or other tests. Although most causes of cognitive impairment cannot be definitely ruled in or out by brain imaging, it can determine the possibility of cerebral small vessel disease, a stroke or mild atrophy of the brain.

Summary

Due to the complexity of testing and need to wait for lab results, it may take more than one visit with the physician to come to any determination. Also, as physicians (and insurance companies) want to exclude more easily treatable conditions first, answers may not be available immediately.

In general, however, the evaluation for cognitive impairment should result in the documentation of:

• The patient’s and family’s concerns
• Any functional impairment the patient is experiencing
• An objective assessment of their memory and cognition
• A thorough examination for any underlying medical causes or contributors to cognitive impairment
• Any possible recommendations or referrals for further examination

If the physician skips any of the suggestions listed, don’t be afraid to ask about it. The health of your loved one depends on a thorough, correct assessment.

It’s also important to realize that if there is an eventual diagnosis of dementia, it may be caused by one or more diseases, which could mean even more tests. For more information read The 10 Most Common Types of Dementia.