Mild memory loss always presents diagnostic and treatment dilemmas. The actual prevalence of Alzheimer’s disease (a major cause of memory loss) changes with age so that it is 1.4% during the late 60s, 2.8% during the early 70s, 5.6% during the late 70s, 11.1% during the early 80s, and jumps to as high as 50% after 85. It is safe to conclude that age trumps all other risk factors if we live past 85.

There are many putative risk factors that may cause memory loss and may also slightly raise the risk of developing Alzheimer’s disease: cardiovascular disease, cerebrovascular disease, high cholesterol, peripheral artery disease, elevated homocysteine, low folate, diabetes, smoking, midlife obesity, short men, adult onset depression, family history, and head injury. The greater the number of risk factors, the greater the risk.

Head injury has received increased attention in recent years because of the increased risk of developing dementia in those who engage in certain sports such as football, boxing, and soccer (I find it sad that we monitor cognitive and memory function for those who play college and professional football but not the rest of us). Moderate to severe head injury often produces clear and enduring deficits in those affected. The most controversial form of head injury is what is called “mild” traumatic brain injury. This is defined as suffering a blow to the head which induces confusion or disorientation, loss of consciousness of 30 minutes or less, and/or post-traumatic amnesia for less than 24 hours.

Most of those suffering from a single mild traumatic brain injury (the risk increases for multiple mild head injuries or concussions) will fully recover. However, an estimated 15% will not have a complete recovery. Furthermore, there is an increased risk for Alzheimer’s disease or frontotemporal dementia in those with head injury. There are no clear estimates of the percentage increase in risk.

Among current hypotheses to explain the increased risk of dementia in those with brain injuries are that head injury speeds up the onset of dementia in those already predisposed and/or that head injury increases the level of beta amyloid (as does stroke) which is the pathology underlying development of plaques. There are overlapping complaints for those with head injury and early Alzheimer’s disease and Mild Cognitive Impairment: memory complaints, slowed thinking, and decision making and problem solving deficits. In mild brain injury the memory deficits respond well to external supports and the problem solving deficits occur early. In Alzheimer’s disease the memory deficits are more severe and problem solving comes as the pathology increases.

Treatment is similar for early stage Alzheimer’s disease and for mild brain injury. Thorough assessment of memory and thinking for a baseline as well as monitoring over time and treatment is essential. Both require a proactive approach that treats working and short-term memory. Treatment needs to be practical and focus on developing memory skills, compensation strategies, family support, and planning for the future in case there will be progressive decline.

Dr. Beckwith will present “Engagement Therapy for Memory Loss” on July 27 sponsored by Arden Courts in Fort Myers (call 454-1277 to register) and a three hour workshop (fee $100 per person/$150 per couple with limited seating) in Naples on August 8 (call 591-6226 to register).