Characteristics of Common Causes of Memory Loss

Age-associated memory impairment

Occasional forgetfulness (eg, of names or location of car keys) but no other impairment of memory

Normal cognitive function

History and physical examination alone

Mild cognitive impairment

Memory impaired

Daily function not affected

Other aspects of cognition intact

History and physical examination

Sometimes neuropsychiatric testing

Dementia (eg, Alzheimer disease, vascular dementia)

Memory impaired

Daily function affected (eg, finding their way around the neighborhood, doing usual tasks at work)

Impairment of at least 1 other aspect of cognition:

• Impaired reasoning and handling of complex tasks (executive function) and poor judgment (eg, being unable to manage bank account, making poor financial decisions)

• Aphasia (language dysfunction), causing difficulty finding words and/or naming objects

• Visuospatial dysfunction (eg, inability to recognize faces or common objects)

• Personality and behavioral changes (eg, suspicion, anxiety, agitation)

History and physical examination

Brief neurocognitive testing (eg, Montreal cognitive assessment or MOCA)

Sometimes neuropsychiatric testing

To identify causes: MRI or CT, lumbar puncture, blood tests

Depression

Memory loss often correlated with severity of mood disturbance

Sometimes sleep disturbance, loss of appetite, psychomotor slowing

Often present in patients with dementia, mild cognitive impairment, or age-associated memory impairment

Memory loss is usually short-term and may be due to lack of concentration or easy distraction related to anxiety and depression

Clinical examination alone

Use of patient questionnaires (eg, Beck Depression Inventory)

Medication and drug use (eg, of anticholinergic medications, antidepressants, opioids, psychoactive agents, or sedatives)

Use of causative medication or substance

Often recent initiation of medication therapy, an increase in dose, or slowing of clearance (eg, caused by decrease in renal or liver function)

Typically a trial of stopping or changing the suspected causative medication or substance