Michael was worried. His primary care physician referred him to me because he was concerned that he was developing Alzheimer's disease. He anxiously recounted, in minute detail, a half dozen instances of memory failure over the past few months, including a forgotten name, a missed appointment, and a wrong exit on the interstate.
As the consultation progressed, I asked a routine question regarding how he'd been faring emotionally. For Michael, this question triggered a pained expression, which darkened his face, and caused him to shift uncomfortably in his chair. He told me he'd been depressed for more than a year, since the death of his grandson in a car accident. Although he received spiritual counseling from his minister, he had not been able to shake the grief, which waited for him every time he sought sleep and each morning upon awakening. He had also become prone to awakening in the early hours of the morning, unable to resume sleep. He felt as if he had been dragging himself out of bed, beginning each day with a sense of exhaustion.
Michael had a neurological examination and a brain imaging study, both of which were normal. My clinical examination revealed the classic signs of depression with weak performance on measures of attention and concentration with mild secondary impairment on tests of new learning and memory.
Michael began psychotherapy to work through his grief over his grandson's death; he also started taking an antidepressant. His depression began to lift and his sleep improved; the medication was discontinued after five months. His neuropsychological examination was entirely normal at a six-month follow-up.
Like Michael, many patients with memory problems who come for evaluation discover that the cause is something that they never imagined could impair their ability to think and remember. Often, the cause is a common condition (such as depression) or a disorder that increases the risk of cerebrovascular disease and heart disease (such as poorly controlled high blood pressure or diabetes). Other causes of memory loss are hormonal changes that occur naturally during certain stages of life. For women, hormonal fluctuations following childbirth and around menopause can make them feel less sharp. Men also go through a phase of significant hormonal change as they age; a drop in testosterone level has been linked with age-related memory problems. Still other causes of memory loss are unhealthy habits (such as excessive alcohol use and getting too little exercise or sleep) or a lack of intellectual challenge.
Fortunately, many causes of memory dysfunction are preventable or treatable. You can consume less alcohol. You can eat sensibly and exercise regularly to reduce your risk of cardiovascular disease and diabetes, both of which can lead to cerebrovascular compromise and reduced blood flow to the brain. I give a complete description of these and other strategies in Chapter 9. In addition, treating underlying conditions that cause memory loss (such as hypertension) can help keep your memory in optimal condition.
Although you can change a multitude of factors that affect the quality of your memory, some causes of memory loss are beyond your control, such as your genetic background.
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