When does occasional absentmindedness signal the start of memory decline?

Feb 17 2005

Forgetfulness is something everyone experiences at one time or another, but at what point does it indicate the beginning of a serious memory loss?

“Everybody forgets things. This is normal, but at some point it could indicate the early stages of a real problem,” said Len Lecci, a clinical psychologist and associate professor of psychology at the University of North Carolina Wilmington. Until now it was hard to tell which.

MARS – Memory Assessment and Research Services – will track subtle memory changes in individuals before major losses occur and, make it easier for clients to receive interventions that help maintain memory.

This new and unique service is a collaborative effort by Drs. Lecci, a clinical psychologist; Julian Keith, a neuroscientist; and Dale Cohen, a cognitive psychologist – all faculty at UNCW. Lecci knows how to assess memory, Keith knows the brain mechanisms of memory, and Cohen develops sensitive tests of memory ability.

The comprehensive MARS assessment includes the “gold standard” of memory tests, the Wechsler Memory Scale; a test of cognitive functioning, the Wechsler Adult Intelligence Scale; a personality profile; a validated measure of current mood, and a clinical interview. Each of these measures adds an important piece of information to better understand the individual and helps rule out other concerns that can sometimes be mistaken for memory problems.

The need for this service is highlighted by the fact that most individuals will not realize it when subtle changes in memory occur and this leads them to depend on family practitioners.

However, Lecci noted that most family doctors aren’t trained to detect memory loss in their patients. This is supported by the most recent Surgeon General report which showed that fewer than 3 percent of cases with mild to moderate dementia and less than 25 percent of those with severe dementia are detected by their physicians.

“Your odds are almost like winning a lottery if early signs of memory loss are noticed by a family physician,” Lecci said. “But that’s understandable, as they have neither the time nor the expertise to do a thorough assessment.”

Although the tests used at MARS are all known to be excellent measures, the new contribution of MARS is the philosophy of administering the tests on a regular basis, ideally yearly.

“A single snapshot of a person’s memory abilities at one point in time is quite limited in terms of predicting how their memory will be in the future,” Keith said.

Lecci explained that the only way to determine if memory is declining is by doing a baseline assessment and taking follow-up tests. He compared it to tracking a hurricane – measuring more than once is the only way to document movement (change) and the more points of reference one has the better one can project the future track it will take.

Lecci also pointed out that a particular challenge is detecting memory problems in people who start out with above-average memory. “Just taking a taking a snapshot (one time) assessment and comparing performance to the average is especially problematic for this type of individual as they will have had to decline a great deal before appearing to have a memory problem. So relying on a one-time assessment is problematic.”

MARS recommends a full memory assessment before individuals (or their families) are aware of any memory loss, then reassessment every few years if memory seems normal and the individual has no risk factors. Risk factors include family history of Alzheimer’s disease or other dementias, diabetes, high blood pressure, or any central nervous system dysfunction. If risk factors exist, another assessment in a year is recommended. If some memory loss is indicated in the first assessment, testing may be recommended within six months.

When is it time to get a memory check?

“It’s when your memory is fine,” Lecci emphasized. Early assessment is critical because medications are available to prevent further memory loss, but nothing is available to recover memory once it is lost.

“There are centers, and doctors, who do memory assessments or work with people already suffering severe memory loss. But the goal of MARS is to target a different group; those who do not currently think they have a memory problem,” Lecci said. When an individual leaves MARS, “you will have information that will be of value both immediately and also in the future as your memory abilities change,” Keith said.

They encourage all clients to share that information with their family physicians, and, at the request of clients, MARS will provide a brief summary of the findings and recommendations that are specifically intended for physician use.

“We believe that family doctors will value the information that we provide their patients,” Keith said. The information provided by the memory assessments can be used to develop an overall treatment plan for the individual. “We provide that critical information, that piece of the puzzle that’s often missing.”

Keith said even just five or 10 years ago, it wouldn’t have made sense to have a center like MARS “because the medications weren’t there.”

And future treatment looks bright. “There is a whole class of drugs in Phase III clinical trials – they attack the problem in a very promising way. They go after the root cause of Alzheimer’s. These new drugs could revolutionize Alzheimer’s treatments,” he said.

“Assessments that detect early memory loss will be important so people can receive those treatments while their brain is still healthy enough to benefit from them,” Keith said. “Breakthroughs on the pharmaceutical front will continue to make what we do more important.”

Families who have seen an aging parent or grandparent suffer with Alzheimer’s have been frustrated by the lack of memory assessment services available. “It heightens your sensitivity to get treatment early” if you know that help is available to prevent the disease from worsening, Keith said.

However, not all memory loss is due to Alzheimer’s disease.

“Memory problems can arise from highly treatable problems,” Keith said. These include hormone imbalances, depression and even stress.

When a physician suspects that a patient may be experiencing memory loss, MARS can carry out the necessary memory assessments and treatment can be developed by the clients’ own physician. But even more important is to get people thinking about memory loss before they experience it. “The idea of a regular memory check-up may sound new now, but that would have been the case for mammograms or prostate exams years ago,” Lecci said.

“If the assessments indicate that there’s no need for concern currently, clients walk away with something of great value, peace of mind,” said Keith.

Lecci agreed. “The ideal scenario is that a client walks away knowing things are fine now and that experts are watching this process in a systematic way.”