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March 2002

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MEMORY PROBLEMS IN THE ELDERLY

Charmaine Hugo, Medical Health Information Centre

"Modern knowledge has changed the misconceptions of memory and old age so that we now have the ability to improve memory."

Good memory is one of our most important health assets. Like so many other bodily functions, we have to also look after our memory to ensure that this asset does not become a liability in old age. 

We all seem to think that memory weakens as we age, but how do we differentiate age related memory problems from a memory illness? Today, treatment is available for poor memory in the elderly, and therefore it has become important to recognise deficient memory. In the past, we believed that it was normal for a person's memory to deteriorate notably in old age. Poor memory in the elderly has been considered untreatable and was also associated with mental diseases known by such harsh names as senility. No wonder psychiatric hospitals were filled with persons suffering from poor memory. Modern knowledge has changed the misconceptions of memory and old age so that we now have the ability to improve memory.

One's memory should be able to assist you in coping with day-to-day living. A person ought to be capable of functioning well in everyday activities such as socialising, meeting appointments and keeping financial commitments. Socialising implies that most names and faces of people can be remembered. Important facts from conversations can be remembered and the same stories are not repeated over and over again. Everyone has appointments that must be kept on a daily basis and this is often accomplished by relying on a diary. Keeping financial commitments signify that bank balances can be remembered and that one can remember to budget.

Notice that normal memory function indicates that the ability to learn and remember newly acquired facts is still intact. This type of memory is called short-term memory. For example one can remember where objects were placed and will only infrequently misplace items. Placement of keys and glasses can also be remembered.

Recalling events from the distant past such as which school was attended or when one got married, is a very stable form of memory and is fairly resistant to the effects of memory illnesses. This is called long term memory.

So, if you have difficulty remembering new things from day to day then you may have a problem with your memory. What should be done when your memory is faulty? Most importantly a diagnosis of the illness that affects the memory, must be made. In the elderly, Alzheimer's disease is usually the cause in roughly 60% of cases. Other causes of poor memory include; deficient blood supply to the brain due to diseases of the brain arteries, depression, thyroid problems, liver problems, vitamin deficiencies, and others.

A medical doctor should perform a test to confirm suspicions of poor memory. The most commonly used test is the Mini-Mental Status Examination and a score of 26 or below indicates poor memory and poor general intellectual function. The next step would be to perform blood tests and often a brain scan is also required. Alzheimer's disease has no specific diagnostic test and is diagnosed by exclusion of other causes together with a characteristic history. Other illnesses are usually excluded by blood tests and a brain scan. The type of brain scan that is required, is called Computed Tomography (CT) scan. Another type of brain scan called a Magnetic Resonance (MR) scan is sometimes required in special situations, this type of scan is also much more expensive. The characteristic history that is found in Alzheimer's disease include a history of slow onset and progressive loss of memory. Personality changes may occur and the most common change in the beginning is lack of interest, otherwise known as apathy.

Once the diagnosis of Alzheimer's disease has been made, treatment for memory impairment should be considered. Three drugs are available in South Africa, Aricept®, Exelon® and Reminyl®. These drugs do not cure the illness but they do improve memory in a certain percentage of patients. Many patients also participate in clinical research studies that evaluate new treatments for Alzheimer's disease.

For more information on any memory-related problems call MIND, a consumer information and support division of the Mental Health Information Centre, at tel. (021) 938 9229. Or call the Memory Line at (021) 939 3152.

Information provided by Dr. Frans Hugo, neuropsychiatrist at the Panorama Memory Clinic.






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