neurologic disorders
Memory Loss
Treatment of Memory Loss
Patients with age-associated memory impairment should be reassured. Some generally healthful measures are often recommended to help maintain function and possibly decrease the risk of dementia. Patients with Treatment are treated with medications and/or psychotherapy. Patients with memory loss and signs of depression should be treated with nonanticholinergic antidepressants, preferably selective serotonin reuptake inhibitors (SSRIs). Memory loss tends to resolve as depression does. Treatment is treated by correcting the underlying condition. Rarely, Treatment is reversible with a specific treatment (eg, supplementary vitamin B12, thyroid hormone replacement, shunting for normal-pressure hydrocephalus). Other patients with memory loss are treated supportively. The following can be recommended for patients who are worried about memory loss: Regular exercise Consumption of a healthy diet with lots of fruits and vegetables Sufficient sleep Not smoking Minimized use of alcohol or other substances (eg, marijuana) Participation in social and intellectually stimulating activities Regular physical examinations Stress management Prevention of head injury These measures, with control of blood pressure, cholesterol levels, and plasma glucose levels, also tend to reduce risk of cardiovascular disorders. Some evidence suggests that these measures may reduce risk of dementia, but this effect has not been proved. Some experts recommend Learning new things (eg, a new language, a new musical instrument) Doing mental exercises (eg, memorizing lists; doing word puzzles; playing chess, bridge, or other games that use strategy) Reading Working on the computer Doing crafts (eg, knitting, quilting) These activities may help maintain or improve cognitive function, possibly because they strengthen neuronal connections and promote new connections. Occupational and physical therapists can evaluate the home of impaired patients for safety with the goal of preventing falls and other accidents. Protective measures (eg, hiding knives, unplugging the stove, removing the car, confiscating car keys) may be required. If patients wander, signal monitoring systems can be installed, or patients can be registered in the Safe Return program. Information is available from the Alzheimer's Association (Safe Return program). Clinicians should know their role in notifying local licensing authorities about patients with dementia; requirements for reporting vary by state (in the United States) and by country. Ultimately, assistance (eg, housekeepers, home health aides) or a change of environment (eg, living facility without stairs, assisted-living facility, skilled nursing facility) may be indicated. Environmental measures can help patients with dementia. Patients with dementia usually function best in familiar surroundings, with frequent reinforcement of orientation (including large calendars and clocks), a bright, cheerful environment, and a regular routine. The room should contain sensory stimuli (eg, radio, television, night-light). In institutions, staff members can wear large name tags and repeatedly introduce themselves. Changes in surroundings, routines, or people should be explained to patients precisely and simply, omitting nonessential procedures. Frequent visits by staff members and familiar people encourage patients to remain social. Activities can help; they should be enjoyable and provide some stimulation but not involve too many choices or challenges. Exercises to improve balance and maintain cardiovascular tone can also help reduce restlessness, improve sleep, and manage behavior. Occupational therapy and music therapy help maintain fine motor control and provide nonverbal stimulation. Group therapy (eg, reminiscence therapy, socialization activities) may help maintain conversational and interpersonal skills. Eliminating or limiting medications with central nervous system (CNS) activity often improves function. Sedating and anticholinergic drugs, which tend to worsen dementia, should be avoided. are modestly effective in improving cognitive function in patients with mild to moderate Alzheimer Disease or Memantine, an NMDA (N-methyl-d-aspartate) antagonist, can be used in moderate to severe dementia. may provide temporary improvement in memory for patients with mild cognitive impairment, but the benefit appears to be modest ( Treatment references ). However, cholinesterase inhibitors are not usually recommended to enhance cognition or memory in patients with mild cognitive impairment because evidence of efficacy is insufficient and risk of adverse events (particularly gastrointestinal [ is a monoclonal antibody that reduces beta-amyloid plaques that accumulate in the brain in patients with Alzheimer Disease . However, the accumulated data have not convinced many experts that 1.Petersen RC, Thomas RG, Grundman M, et al:Vitamin Eanddonepezilfor the treatment of mild cognitive impairment.N Engl J Med. 352 (23):2379–2388, 2005. doi: 10.1056/NEJMoa050151 Epub 2005 Apr 13. 2.Russ TC, Morling JR: Cholinesterase inhibitors for mild cognitive impairment.Cochrane Database Syst Rev2012 (9): CD009132, 2012. Published online 2012 Sep 12. https://doi.org/10.1002/14651858 CD009132.pub2 