Presenting Complaints

• Patients may complain of forgetfulness, or feeling depressed but may be unaware of memory loss.
• Families ask for help:
• initially because of failing memory, change in personality or behaviour.
• in later stages because of confusion, wandering, incontinence.
• Poor hygiene in an older patient may indicate memory loss.
  

Diagnostic Features

• Decline in recent memory, thinking and judgment, orientation, language, social adjustment.
• Often appear apathetic or disinterested, but may appear alert and appropriate despite poor memory.
• Loss of emotional control - may be easily upset(tearful, irritable).
• Common in older patients, very rare in youth or middle age.
• Tests of memory and thinking include:·
  • Ability to recall names of 3 common objects immediately and after 3 minutes.
  • Ability to name days of week in reverse order.

Differential Diagnosis

• Examine for medical illness causing memory loss. Examples include:
  • Vitamin B12 or Folate deficiency
  • Hypothyroidism · Syphilis
  • Normal Pressure Hydrocephalus
  • Subdural Haematoma
  • HIV Infection
• Prescribed drugs or alcohol can affect memory and concentration.
• Sudden increases in confusion may indicate a medical illness or toxicity from medication.
• If confusion, rapidly changing attention and behaviour are present, see Delirium F05.
• Depression may interfere with memory and concentration, especially in older patients. If low or sad mood is prominent, see Depression F32.