Have you been worried about an older person’s memory or thinking abilities?
Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.
Or you may have noticed false accusations, or irrational worries getting out of control.
These are very common concerns, and they often lead to questions such as:
- Is this normal aging or something more significant?
- What is wrong?
- Could this be Alzheimer’s? Or some other form of dementia?
- Can these memory problems be treated or reversed?
- What should we do about this??
The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.
That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.
Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.
Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”
(For more on “cognitive aging” and what types of changes are considered normal aging, see this article: 6 Ways that Memory & Thinking Change with Normal Aging, & What to Do About This.)
Cognitive impairment — which is also called “cognitive decline” — can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.
In this article, I’ll share with you the more common causes of cognitive impairment in older adults.
I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive decline in an older adult.
You can also watch a subtitled video version of this information below.
Common causes of cognitive impairment in older adults
Cognitive impairment, like many problems in older adults, is often “multifactorial.” This means that the difficulties with memory, thinking, or other brain processes are often due to more than one cause.
Common causes of cognitive impairment in older adults include:
- Medication side-effects. Many medications interfere with proper brain function.
- Sedatives, tranquilizers, and anticholinergic medications are the most common culprits. For more information, see 4 Types of Medication to Avoid if You’re Worried About Memory.
- “Metabolic imbalances.” This term refers to abnormalities in one’s blood chemistry.
- Examples include abnormal levels of blood sodium, calcium, or glucose.
- Kidney or liver dysfunction can also cause certain types of metabolic imbalances, and these sometimes affect brain function.
- Problems with hormones, such as thyroid hormones.
- Imbalances in estrogen and other sex hormones may also affect cognitive function.
- Deficiencies in vitamins and other key nutrients.
- Brain function is especially known to be affected by low levels of vitamin B12, other B vitamins, and folate.
- Delirium. This is a state of worse-than-usual mental function that can be brought on by just about any type of serious illness.
- Delirium is very common in hospitalized older adults, and can also occur due to infection or other health problems in older people who are not hospitalized.
- Psychiatric illness. Most psychiatric conditions can cause problems with memory, thinking, or concentration. Psychiatric illnesses can also cause paranoia and other forms of late-life psychosis.
- Depression and anxiety are probably the most common psychiatric conditions in older adults.
- It is also possible for older adults to have bipolar disorder, schizophrenia, or other forms of major mental illness; these have often been diagnosed earlier in life.
- Substance abuse and/or substance withdrawal.
- Both acute intoxication and chronic overuse of certain substances (such as alcohol, illicit drugs, or even prescription drugs) can impair brain function.
- Damage to brain neurons, due to an injury.
- “Vascular” damage to neurons means damage caused by problems with the blood vessels, such as strokes or some form of cerebral small vessel disease.
- Head injuries are also associated with temporary or longer-lasting cognitive impairment.
- Damage to brain neurons, due to a neurodegenerative condition.
- Neurodegenerative conditions tend to slowly damage and kill neurons. This can cause mild cognitive impairment, and then eventually dementia.
- The more common neurodegenerative conditions include Alzheimer’s disease, Lewy-Body disease, Parkinson’s disease, and frontotemporal degeneration.
- Infections.
- Historically, this has not been as common in older adults as the other causes above, but certain chronic or acute infections can affect brain cells directly. (If cognitive impairment is caused by an infection outside the brain, such as pneumonia or a urinary tract infection, this would be considered delirium.) More recently, the COVID virus has become fairly prevalent; it does affect brain cells in some cases, and research is ongoing to learn more about this.
Toxins are another potential cause of cognitive impairment. Research is ongoing as to the cognitive effects of toxins people may be exposed to, such as heavy metals, air pollutants, contaminants in our drinking water, pesticides, and others.
Poor sleep and/or high levels of stress are two additional factors to consider, as the brain works less well under these conditions. (For more on sleep problems in aging, see here.)
Now that I’ve covered the most common causes of cognitive impairment in older adults, here’s what an initial medical evaluation should generally cover.
10 Things the Doctor Should Do When Evaluating Cognitive Impairment in an Older Adult
Here are ten specific things the clinician should ask about, check on, or do, as part of an initial evaluation for cognitive impairment in an older adult.
The following list reflects my own practice and that of most geriatricians. It is in line with most syntheses of guidelines and best practices, including the UpToDate.com chapter on this subject.
Most experts agree that these steps can be done by primary care clinicians.
1. Ask about and document the patient’s concerns about memory and thinking.
At a minimum, the clinician should ask an older person something like “So, have you noticed any changes in your memory or thinking abilities?”
Now, many older adults will either have noticed nothing or won’t want to talk about it. This is in of itself worth noting, especially if family or others have voiced concerns.
If the older person does have concerns or observations, these should be explored. It’s especially important to ask when the problems started, whether they seem to be getting worse, and how quickly things seem to be changing.
(Wondering how to talk to an older person about their memory loss? I explain how to do this here.)
2. Obtain or request information on memory or thinking difficulties from family members or other “informants.”
Older adults with cognitive impairment are often unaware of — or reluctant to reveal – the difficulties they are experiencing. For this reason, a health provider who has been alerted to the possibility of cognitive impairment should make an effort to get information from a family member or other knowledgeable informant.
The best is to ask a family member to complete a validated questionnaire, such as the AD-8 informant interview. (This questionnaire asks about 8 behaviors that may indicate a dementia such as Alzheimer’s disease.)
It’s sometimes necessary for the health provider to be diplomatic about requesting and getting information from family members, especially if the older person finds it upsetting. People may think that HIPAA doesn’t allow doctors to talk to family over an older person’s objections, but actually, clinicians do have some leeway in these situations. (See my HIPAA article here.)
Family members can facilitate this process by bringing in a written summary of what difficulties they’ve observed. Be sure to include information on when the problems started and whether they seem to be getting worse.
3. Ask about difficulties managing instrumental activities of daily living (IADLs) and activities of daily living (ADLs).
The ideal is for the health provider to ask both the patient and the family about this. Older adults with cognitive impairment are often not reliable reporters of what difficulties they’re having.
Instrumental activities of daily living (IADLs), in particular, are often affected by cognitive impairment. So it’s important to ask if the older person is having difficulty with problems with tasks such as:
- Driving and other forms of transportation
- Management of finances
- Grocery shopping and meal preparation
- Home maintenance
- Managing the telephone, the mail, and other forms of communication
- Medication management
The provider should also ask about ADLs, which are the more fundamental self-care tasks such as walking around, feeding oneself, getting dressed, managing continence, and so forth.
You can learn more about ADLs and IADLs here: What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)?
Difficulties with IADLs and ADLs (which geriatricians refer to as “functional impairment”) are important to document. They offer a practical lens on how “severe” an older person’s cognitive impairment might be, and on what steps could be taken to support an older person while these cognitive issues are getting evaluated.
Functional impairments may correspond with safety issues that need to be addressed; if an older person is having difficulty with finances, it may be a good idea to check for signs of financial exploitation, or otherwise take steps to protect the person financially.
Last but not least, impairment in daily functioning is also a criterion that separates mild cognitive impairment (MCI) from more significant impairment (including dementia). In MCI, a person may be experiencing some cognitive impairment, but it should not be bad enough to significantly interfere with performing their usual daily life tasks.
4. Check for the presence of other behavioral, mood, and thinking symptoms that may be related to certain causes of cognitive impairment.
These include:
- Hallucinations
- Delusions
- Personality changes
- Apathy (losing motivation)
- Depression symptoms
- Anxiety symptoms
- Getting lost
- Confusion about visual-spatial tasks (e.g. having difficulty figuring out how to put on one’s shirt)
5. Ask about any new symptoms or changes in physical health.
It’s especially important to ask about symptoms related to neurological function, such as new difficulties with walking, balance, speech, and coordination. Checking for tremor and stiffness (both of which are associated with Parkinsonism) is also recommended.
The exact questions the clinician asks will depend on the person’s particular medical history, and the other signs and symptoms that have been brought up.
6. Ask about substance use and consider the possibility of substance abuse and/or withdrawal.
Excessive use of alcohol, certain prescription drugs (such as tranquilizers), or of illicit drugs can affect cognitive function. Health providers should inquire about an older person’s use of these substances.
Suddenly stopping or reducing the use of alcohol or other substances can also occasionally cause or worsen cognitive function.
7. Review all medications, with a focus on identifying those known to worsen cognitive function.
Certain types of medications tend to dampen brain function, and may cause a noticeable worsening in cognitive abilities. The health provider should especially ask about use of:
- Benzodiazepines, which are often prescribed for either insomnia or anxiety
- Commonly prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
- Prescription sleeping pills, such as zolpidem (brand name Ambien)
- Anticholinergics, a broad category of medications which includes most over-the-counter sleeping aids, sedating antihistamines, drugs for overactive bladder, muscle relaxants, and others.
- For more information on the most common anticholinergics, see 7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.
For more on medications that affect brain function, see 4 Types of Medication to Avoid if You’re Worried About Memory.
8. Perform a physical examination.
At a minimum, the health provider should check vitals (blood pressure and pulse) and should also complete a basic neurological evaluation, including an observation of the person’s gait, balance, and coordination.
The purpose of the physical exam is to look for physical signs that may correspond to causes of cognitive impairment, or that may relate to other symptoms the patient or family brought up.
9. Assess the person’s orientation and perform some type of office-based cognitive test.
Assessing “orientation” means checking to see whether the patient knows things like the day, date, month, year, and where he or she is.
Some office-based testing should also be done, to check and document the older person’s memory and thinking abilities.
Probably the shortest well-validated test is the Mini-Cog, which involves a three-item recall and a clock draw.
A more detailed office-based cognitive test that can be done in primary care is the MOCA test (Montreal Cognitive Assessment Test). This takes 10-20 minutes to administer, so it often requires scheduling a separate visit.
There are some other “intermediate” length tests that can be done in the primary care office, such as the SLUMS (St. Louis University Mental Status Examination). The Mini-Mental State Exam is another option, although most experts (including myself) consider it less useful than the MOCA or SLUMS.
10. Order laboratory testing (unless recently done) and consider brain imaging.
In most cases, it will be appropriate for the health provider to order blood tests, to check for common health problems that can cause or worsen cognitive impairment.
Blood tests to consider include:
- A complete metabolic panel, which assesses electrolytes, kidney function, and liver function tests
- Vitamin B12
- Thyroid function tests
Additional tests, such as a complete blood count, may be ordered as well, depending on the person’s past medical history, current symptoms, and risk factors. For more on tests that are often ordered in older adults, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
As for brain imaging, some expert guidelines recommend it for everyone and other guidelines suggest it be used “selectively.”
(In most cases, brain imaging reveals non-specific findings such as signs of cerebral small vessel disease and perhaps some mild atrophy of the brain. These are common findings in many older adults and tend to have a variable correlation with symptoms. Most causes of cognitive impairment cannot be definitely ruled in or ruled out by brain imaging.)
In Summary
Overall, an initial medical evaluation should result in these four key things happening:
- Documentation of the patient’s and family’s cognitive concerns.
- This means documenting what the patient and family have noticed, in terms of difficulties and changes in memory, thinking, behavior, or personality.
- Documentation of any functional impairment the older person is experiencing.
- This means documenting what the patient and family have noticed, in terms of difficulties managing life tasks (IADLs and ADLs).
- An objective assessment of the older person’s memory and thinking skills.
- This best done through some form of short standardized office-based test, such as the Mini-Cog.
- Clinicians can also document their impressions and observations based on talking to the older person. (Did the person seem confused? Paranoid? Repetitive? Tangential? Was the person able to answer detailed questions?)
- An evaluation for common medical causes and contributors of cognitive impairment.
- This means checking for those common problems that can cause or worsen cognitive impairment.
Generally, it will take at least two primary care visits to complete an evaluation for cognitive impairment.
The second visit is often used to do a cognitive test such as the MOCA, and can enable the clinician to follow up on laboratory tests that were initially ordered.
And then what?
Well, what happens next depends on several things, such as:
- Whether the health provider was able to draw conclusions about what is likely causing the cognitive impairment
- Whether treatable conditions were identified
- How the patient and family feel about the evaluation
- Whether the older person is willing and able to cooperate
- Whether the clinician feels that referral to a specialist is necessary
- Whether the clinician is willing and able to help the older person and the family (or refer them for help) addressing any functional impairment or safety issues
You may be wondering: should you expect a diagnosis or “an answer” after this evaluation?
I’ll be honest here: probably not. Even with an adequate initial evaluation, cognitive impairment may take a few months (or even longer) to completely evaluate and diagnose. For instance, it’s often necessary to try treating one or more potential causes, to see if the cognitive problems improve or not.
Other causes of cognitive decline — notably neurodegenerative conditions such as Alzheimer’s and some of the other dementias — can take a while to diagnose because clinicians are first supposed to exclude the other potential causes, and that can take a while. (For more on the diagnosis of dementia, see “How We Diagnose Dementia: The Practical Basics to Know.)
What to expect from an initial evaluation for cognitive decline
It may not be realistic to expect definite answers. But that doesn’t mean you can’t expect some explanations.
Your health provider should be able to explain:
- How substantial the cognitive impairment appears to be, based on the office-based testing and the evaluation so far,
- What was checked for, and what has been ruled out (or deemed unlikely) as a cause for the problems you’ve been worried about,
- Whether any of the medications might be making memory or thinking worse, and what the options are for stopping or reducing those medications,
- What the healthcare team proposes to do next, to further evaluate the issues or follow up on the problems.
So if you’ve been worried about memory or thinking problems, ask for that medical evaluation. If your health provider skips any of the steps I listed, don’t be shy and ask about it. (Either it’s an oversight or they should be able to explain why it’s not necessary.)
You probably won’t get all the answers and certainty that you’re hoping for, but you’ll have gotten started and that’s vitally important.
Of course, you may well be facing the problem of not being able to get your older loved one to go to the doctor. That’s a very common issue, but it’s too complicated to cover in an article. (So I’ve written a book! You can find it here.)
In the meantime, especially if it’s a challenge to see the doctor for some reason, then it’s all the more important to the most out of your medical evaluation when you do manage to get there.
This article was originally published in 2018, and was last reviewed by Dr. Kernisan in Dec 2023.
Kathy Jensen says
There are many OTC supplements for memory issues. What kinds of memory supplements might be good to try? Or a source/website to help sort them out?
Nicole Didyk, MD says
There are no dietary supplements or vitamins that have been shown to reverse or prevent dementia. Many compounds have been studied and some of them can sometimes seem to improve performance on some cognitive tests, but there is nothing that haws shown an improvement in day to day function, or a slowing of deterioration due to Alzheimer’s or another kind of dementia.
That said, if a person has a vitamin deficiency, then replenishing the deficient compound could very well improve brain health. Vitamin B12 is an example.
Otherwise, avoid spending money on unproven supplements that are unlikely to help anyone but the manufacturer of the supplement.
Linda Kline says
What a great article Dr. K. I encourage family members who are concerned about cognitive decline of an aging parent to advocate and keep advocating. I wish I had all this information years ago when I was concerned about my mom. She refused to let me go with her to the doctor a couple times until I made up something maybe her doctor could help me with. I had to be discreet and wrote a note to the doctor to read before coming into the exam room. Honestly, the doctor took BP, pulse and asked mom if she was worried about her memory. Mom, of course, wasn’t. I tried to explain my concerns and was told we could talk about possibly getting an MRI at a future visit. That’s it! Months later, when the doctor didn’t mention it, I specifically said she had mentioned an MRI and I was more and more concerned. The doctor wasn’t, but I pushed for a referral to see a neurologist. After neurology assessment and MRI, my mother was diagnosed with Alzheimer’s. She was already beyond what Aricept could do and was started out on Namenda. It was such a frustrating process. I’m so glad others can refer to your article and really know what to ask. Thank you so much.
Nicole Didyk, MD says
Hi Linda and thanks for sharing your story. I hear so often about children having to advocate repeatedly for their parent to get the right help, especially when it comes to diagnosing and treating dementia. I’m sorry it was so frustrating for you, but it sounds like you did a good job of persisting to get answers.
Other resources include my own website http://www.TheWrinkle.ca, where I have a lot of videos about aging and dementia.
Dr. K. has a book coming out soon called: “When Your Aging Parent Needs Help: A geriatrician’s step-by-step guide to memory loss, resistance, safety worries, & more”. Stay tunes to find out how to get a copy, I think you’d find it very helpful.
Andrea says
This is really helpful! These are things I wish I knew when my mom was still alive. I will pass it along to my patients. Appreciate your work.
Nicole Didyk, MD says
I’m so glad you found the article helpful and please do share it!
Shelley says
My mother is 82 and has always been very independent. Her very best friend was diagnosed with Alzheimer’s several years ago and it broke mom’s heart. She was in denial for a while and then seemed to begin to accept. The end of 2018, mom became depressed and it seemed to the family, that she had decided to give up on living. She has continued to decline cognitively and physically. Her Doctor has run every test imaginable, and all come out normal. She has had CT scans also. They ruled out thyroid dysfunction, diabetes/hypoglycemia, brain tumors, strokes, sepsis, dementia, dehydration, electrolyte abnormalities, kidney failure, liver failure, b12 deficiency. Doctor is thinking it looks more psychological, because she can randomly make cognitive comments. Have you ever seen this behavior? If so, do you have a suggestion for what we should do next? She is taking 20mg of Paroxetine (Paxil). She had been on Prozac but did not seem to help.
Thank you for any guidance you can give us.
Nicole Didyk, MD says
It must be so hard to see your mom suffer and feel like you don’t have all the answers. You mention depression and dementia, and it can be hard to distinguish those conditions from each other, and sometimes they are both present. A thorough search for other medical issues that could be contributing to mood changes is vital for an older patient, as you mention.
Depression in later life can be complex to diagnose and treat, and a person usually has to be on a good dose of the right medication for several weeks to se if there’s going to be an effect. The medications that you mention are not the typical “first-line” choices in older adults, although the family that they belong to, selective serotonin reuptake inhibitors (SSRI’s) are used very commonly in Geriatrics.
In all individuals with depression, adding in psychotherapy (talking to a counselor) and exercise is likely to help, especially when used together with antidepressant drugs. Primary care providers have a lot of expertise when it comes to managing depression, but I often refer my patients to a Geriatric psychiatrist for additional guidance.
Rob says
I noticed the odd memory problem starting for myself in November 2020. At the time I was tappering off klonopin and also suffer Bipolar disorder, Ocd, and anxiety problems. So im not sure one or all these issues are to blame. Just wondering if these other disorders are to blame.
Nicole Didyk, MD says
Assuming you mean November 2019, so about 6 months ago? Mental health issues can definitely affect memory performance. When a person is anxious or depressed, it can affect concentration, memory and more. I made a YouTube video that discusses these issues, and you can watch it here.
Cathie says
Your articles are excellent, as well as to all the responses you take the time to write. Thank you. We live with my mom and haven’t noticed any real issues other than she is unaware of the fact that she is becoming incontinent of urine and that her clothes smell terribly. I’ve discussed it with her 6 times, and she still doesn’t seem to be doing anything about it. I’ve tried to encourage her to see her doctor, but she rarely goes and is resisting. She seems totally oblivious to it.
Could it be denial?
Nicole Didyk, MD says
Hi Cathie and thanks for your positive feedback. With aging, there can be changes to a person’s sense of smell, and loss of olfactory abilities can be an early sign of Alzheimer’s. It may be that your mom doesn’t notice the odour as much as you do.
In terms of why she isn’t seeking help, it may be that she thinks incontinence is just a normal part of aging, or she could be embarrassed. Many causes of incontinence are treatable, as I discuss in my YouTube video.
I’m sure it’s not pleasant reminding your mom of this so often, so maybe suggesting she go see the doctor for another reason, and trying to accompany her to a visit could be helpful. It could be a sign of dementia if she isn’t remembering the conversations that you’re having, so an assessment would be a good next step.
Robert S says
I am 66 and have a full time job in corporate finance, rather stressful. I have high blood pressure and take 10mg of Amlodipine in the morning. I have three areas of concern, getting a good nights sleep, occasional anxiety in social situations, and short term memory issues. For years I took 1.5mg of Lunesta for sleep most nights. I have tried to eliminate this altogether. For anxiety, I will take a dose of Inderal which helps keep me calm but it makes my heart rate go too low. Years ago I used to take Lexapro for depression/anxiety and it definitely helped with anxiety, but I am reluctant to take it now because I think it may affect my short term memory. Mainly, I’m asking for advice on meds to help anxiety (which I feel most days) that will not take a toll on my short term memory loss. Thank you.
Nicole Didyk, MD says
Hi Robert and thanks for sharing your story. I’m glad you’re working on eliminating the lunesta (eszopiclone), as we generally discourage the use of sleeping pills on a long-term basis. They tend to stop working, which often leads to a person taking higher and higher doses over time, with more side effects.
You’re correct in noting that medications that we use for anxiety or depression (they often treat both) can interfere with cognition. This is thought to be related to their anti-cholinergic properties, and we even have a rating scale to help us determine how anti-cholinergic a medication is.
Escitalopram (aka Lexapro or Cipralex) does have some anticholinergic properties, but not as much as some other anti anxiety drugs (like amitryptiline, fluoxetine or many benzodiazepines). There isn’t a medication for anxiety or depression that doesn’t have some potential to affect brain function – that’s kind of what makes them work in the first place!
If a person is experiencing daily anxiety symptoms and wants to avoid medication, there are other strategies that might help, such as exercise, meditation and cognitive behavioural therapy.
Hope this information is helpful!
NJ says
In the last 3 months I’ve seen a noticeable mental decline in my mother. About 3 months ago the doctor diagnosed her with pre-diabetes which seemed to send her into a mild state of depression (She is prescribed Metformin and already takes pills for hypertension and high cholesterol. She also takes a daily multivitamin and calcium pill). Within 2-3 weeks she withdrew from all outside activities and refuses to drive or cook. Simple math was really hard for her to do. She seemed to improve, her math skills are back but In recent weeks she is exhibiting other signs. She doesn’t sleep through the night. She wants to lay around all day, but won’t watch tv or even listen to the radio. She doesn’t want to leave the house because she feels unsafe. She thinks someone is coming to get her and insists ‘she has lost it’. She doesn’t want to be alone and wakes nearly every hour anxious about some new subject. She is forgetting thinks like taking pills and paying bills. She can’t make a decision on what to eat – she literally gets stressed out trying to make a decision on what to eat at every meal. But then complains about whatever gets given to her. She will not take any sleep aids the doctor has prescribed. I’ve talked with her primary care physician several times about the issues I’m seeing. I was able to convince him to give a referral for a diabetes doctor and a psychiatrist about 6 weeks ago. However I’m being told by the respective offices that the earliest they can even review the referral to schedule an appointment is in Feb. For the past month I take her walking each morning for 2 miles. She seems much better immediately after, but it doesn’t last the whole day. I’ve also noticed she ‘perks up’ for a bit when she gets calls from my siblings. What can I do to get more help now. I am in desperate need to figure out how to help my mom. My mom is on Medicare and I don’t have a lot of money for private programs. I really need to know should I be a bigger ‘nag’ with her primary care office or just continue to check biweekly for any new movement for the doctors to see her? What else can I do to help I the meantime.
Nicole Didyk, MD says
Hi NJ, and thanks for your detailed information! You sound like a wonderful advocate and support to your mother, and that is commendable. Your description of the changes you’re seeing are suggestive of depression but could be due to other medical issues, or could be related to a cognitive impairment, like dementia. Sometimes it’s hard to tell these two conditions apart, and sometimes they are both present.
It’s understandable that you’re worried and want to have your mom assessed as soon as possible, and waiting is very frustrating. I practice in Canada, where “nagging” doesn’t necessarily help to speed things up, but does take a lot of energy on your part. I advise people to seek urgent attention if there is a sudden, alarming change in the person’s condition, or if they start to talk about harming themselves or others, which you don’t describe, thankfully.
In the meantime, I think your idea about exercise is excellent, and looking online for support is also a good idea. You might also consider Dr. Kernisan’s Helping Older Parents Course.
Dennis R Goggins says
Dr. Kernisan,
I enjoyed your article. While not exclusive to aging, CSF Leak with SIH can cause significant cognitive impairment. What is your opinion on this?
Thanks, Dennis
Nicole Didyk, MD says
Hi Dennis, and thanks for your question. Leakage of the CSF (cerebrospinal fluid) can cause symptoms that can resemble cognitive impairment. It’s usually associated with headaches, tiredness and an improvement in symptoms when one has been lying down for an extensive period of time. It can occur in any age group as you mention, most commonly in the 40’s and 50’s. Most of the symptoms are related to the spontaneous intracranial hypotension that you mention. This is sort of a loss of the pressure in the brain and causes the brain to sag a little bit inside of the skull.
Having done a quick review of the literature there is not much known about the association of CSF leak with SIH and dementia. I would say that this is a pretty rare cause and can also be difficult to diagnose so unless somebody is having very unusual symptoms it is pretty low down on our list of potential causes of cognitive impairment.
Dan says
I am a retired veteran who is 100% service related disability, I was diagnosed 2 years ago with TBI (5 concussions in the USCG) and cognitive disorder. I also have Chronic Migraines with aura ( I get Botox every 3 months by the VA), PTSD, Anxiety, major depression, and frontal lobe dementia. My question is can some of these symptoms be related to chemicals or toxins, (I was on board a USCG Ship during 911 and also around ground zero and also another USCG Ship that had asbestos everywhere ) we were there for almost 4 months. (I cannot work anymore due to these issues. I also see a neurologist (but I don’t seem he gives me any information on my issues or what are my future issues will be) and also a physiologist.
Nicole Didyk, MD says
Hi Dan and I am sorry to hear about your many challenges.
There has recently been some study of the long-term effects of being a responder at 9/11, and there may be some association with that and mild cognitive impairment (which can be a precursor to dementia), at least in this study.
It’s a complicated question though, as we know that dementia risk is related to many things, including head injury (concussion), depression, genetic factors, and emotional trauma.
Some toxins, like lead, manganese and other heavy metals are definitely related to cognitive impairment,but again it is often very difficult to prove a causative relationship between those exposures and a neurological condition.
Given the complexity of your situation it’s also probably difficult to predict how things will go in the future but it sounds like you do have some medical professionals to work with. Best of luck.