What we need to know about age related memory loss. (Clinical Review).

Summary points

Patients with mild memory loss are common in clinical practice; if their symptoms warrant a diagnosis of dementia, treatment with cholinesterase inhibitor drugs is needed

Doctors need to be cautious about unproved treatments for slowing brain ageing because of potential side effects

Lifestyle choices may protect people with mild forms of age related memory loss from future decline: essentially, what is healthy for the body is healthy for the brain

The risks of these interventions are minimal and are not likely to outweigh the many benefits

As doctors and scientists have focused more attention on Alzheimer's disease and related dementias, patients are expressing greater concern about their common, age related memory changes. When results of new research on early detection and prevention reach a wider audience, our patients often come to the office with questions about what they can do to preserve their memory abilities as they age. Many of today's doctors trained during a time when minimal information was provided on these topics during their medical training. This paper will provide a practical strategy for assessing age related memory loss and will discuss interventions that may or may not protect brain health.

Sources and selection criteria

The viewpoints presented were based on my clinical experience and a databased literature review. I selected articles with Medline searches using key words relevant to the theme of this review, emphasising peer reviewed journals and data from controlled clinical trials or methodologically sound epidemiological studies when available.

Definitions

With age comes the increasing likelihood of developing memory loss. The mildest form, age associated memory impairment, is characterised by self perception of memory loss and a standardised memory test score showing a decline in objective memory performance compared with younger adults. (1) About 40% of people aged 65 or older have age associated memory impairment--in the United States, about 16 million people. Only about 1% of them will progress to dementia each year.

Mild cognitive impairment represents a more severe form of memory loss and is often defined by important memory deficits without functional impairments. Although patients with mild cognitive impairment are able to continue to live independently, they show objective memory impairments similar to those seen in people with very mild Alzheimer's disease. (2) About 10% of people aged 65 years or older have mild cognitive impairment, and nearly 15% of them develop Alzheimer's disease each year. Studies of drugs to treat mild cognitive impairment in order to delay the onset of Alzheimer's disease are currently in progress.

As people live longer, the risk for developing Alzheimer's disease increases dramatically. Although it is the most common cause of late life dementia, other causes, particularly vascular disease, contribute to the occurrence of dementia, often defined as impairment in several cognitive domains including memory to the extent that it interferes with daily life. (3)

Assessment

Because age related memory change may signal treatable medical conditions, it is important to take any complaint seriously. Risk factors that should …