symptoms of brain spinal cord and nerve disorders
brain, spinal cord, and nerve disorders
Memory Loss
When evaluating memory loss, doctors first determine whether the cause is Delirium or another reversible cause. Reversible causes require immediate treatment. Doctors then focus on determining whether the cause of memory loss is normal age-related changes in the brain, mild cognitive impairment, depression, or early dementia. In people with memory loss, certain symptoms are cause for concern: Difficulty doing usual daily activities Difficulty paying attention and fluctuations in level of consciousness—symptoms that suggest delirium Symptoms of depression (such as loss of appetite, suicidal thoughts, difficulty sleeping, and slowing of speech and general activity) People with warning signs should see a doctor. They should see a doctor immediately if they Cannot pay attention and seem very confused, unfocused, and disoriented—symptoms that suggest delirium Feel depressed and are thinking of hurting themselves Have other symptoms that suggest a problem with the nervous system, such as headaches, difficulty using or understanding language, sluggishness, vision problems, or dizziness People who do not have warning signs but are concerned about their memory or have difficulty doing basic daily activities should call their doctor. The doctor can determine how quickly they need to be seen based on other symptoms they have and the severity of the symptoms. Doctors ask about the person’s symptoms and Medical History in Neurologic Disorders . Doctors then do a physical examination. Having a family member present is helpful because people with memory difficulties may not be able to describe their symptoms accurately. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Doctors often talk to the person and the person’s family members separately because family members may not feel free to describe the symptoms candidly with the person listening. Doctors ask specific questions about the memory loss: What types of things the person forgets (for example, whether the person forgets words or names or gets lost) When the memory problems started Whether memory loss is getting worse How the memory loss is affecting the person’s ability to function at work and at home Doctors also ask whether the person has other symptoms, such as difficulty using or understanding language and changes in their eating and sleeping habits or mood. They ask about all disorders the person has had and all the medications, illicit drugs, over-the counter medications, and nutritional supplements the person is taking to check for possible causes. Doctors also ask the person about any unusual dietary habits. Information about the person’s education, jobs, and social activities can help doctors better assess the person's previous mental function and gauge the severity of the problem. Doctors ask whether any family members have had dementia or early mild cognitive impairment. During the physical examination, doctors evaluate all body systems but focus on the nervous system ( Neurologic Examination ), including evaluation of mental function (mental status testing). In Mental Status , doctors ask people to answer questions or do specific tasks to evaluate various aspects of mental function, such as Orientation to time, place, and person: State the current date and place and who they are. Attention: Repeat a short list of words. Concentration: Spell "world" backwards or repeat their phone number forward, then backward. Short-term memory: Recall the short list of words after several minutes. Long-term memory: Answer questions about the distant past. Use of language: Name common objects and body parts, and read, write, and repeat certain phrases. Ability to understand spatial relationships: Copy simple and complex structures (for example, using building blocks) and draw an object such as clock, cube, or house. This testing also assesses abstract thinking, comprehension, the ability to follow commands and solve math problems, awareness of the illness, and mood. Doctors can usually determine whether the cause is age-related changes, mild cognitive impairment, or early dementia based on the type of memory loss and the symptoms that accompany it. However, when the diagnosis is unclear, neuropsychologic testing can provide more information. This testing is similar to mental status testing except it is much more detailed. Complete testing may take hours. These tests must be given by a trained, licensed psychologist or psychiatrist with expertise in memory loss. These tests may not be as useful in people over 65. If doctors suspect dementia or find any abnormalities during the neurologic examination, they usually do magnetic resonance imaging (MRI) or, if MRI is unavailable, computed tomography (CT) to check for abnormalities such as a brain tumor, normal-pressure hydrocephalus, damage due to a head injury, and stroke. Doctors may also do blood tests to measure levels of vitamin B12 and thyroid hormones to determine whether vitamin B12 deficiency or a thyroid disorder could be causing memory loss. These disorders are reversible causes of memory loss. If a brain infection is suspected, doctors usually do a Spinal Tap (lumbar puncture) to obtain samples of the fluid around the brain (cerebrospinal fluid) for analysis. 