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subjective memory problems in the elderly

Etiology: - awareness of memory loss is increased in patients with dysthymia & anxiety [3,7] - Herpes zoster (RR=1.1) Pathology: - associated with increased amounts of neuritic plaques in neocortex & medial temporal lobe [7] Clinical manifestations: - many older adults with self-reported memory loss do well on routine memory tests & further neuropsychologic testing - memory impairments are pathological if they interfere with activities of daily living (i.e. forgetting to pay bills) [5] Special laboratory: - neuropsychologic testing not routinely indicated [5] Complications: - subjective memory impairment predicts development of dementia [1,4,7]* - general change in ability to remember things - trouble remembering short lists - trouble remembering recent events - difficulty understanding instructions (learning & executive function) - trouble following a group conversation or a TV program's plot (attention deficit) - trouble finding one's way around familiar streets (executive function) * memory problems & problems with executive function that interfere with activities of daily living such as making mistakes in finances, forgetting to pay bills is best indicator of pathologic neurologic decline [5] Management: - cognitive training has little impact on ADLs [2] - mindfulness training, exercise, or a combination of both of no benefit [9] Clinical trials: 1) Wang et al [1] a) 1883 patients age >64, median age 75 b) not demented at start of trial c) followup of 5 years [1] d) results: - 126 patients (6.7%) developed dementia by DSM IV criteria - 15% of patients with subjective memory impairment at baseline developed dementia - 6% of patients without subjective memory impairment at baseline developed dementia - 144 patients (7.6%) died or discontinued trial

Related

elderly (senior citizen) neuropsychiatric features of aging subjective

General

memory impairment geriatric disorder; disease of old age; geriatric syndrome

References

  1. Journal Watch 25(3):29, 2005 Wang L, van Belle G, Crane PK, Kukull WA, Bowen JD, McCormick WC, Larson EB. Subjective memory deterioration and future dementia in people aged 65 and older. J Am Geriatr Soc. 2004 Dec;52(12):2045-51. PMID: 15571540
  2. Willis SL et al for the ACTIVE Study Group Long-term effects of daily cognitive training on everyday functional outcomes in older adults JAMA 2006, 296:2805 PMID: 17179457 - Shumaker SA et al, Behavior-based interventions to enhance cognitive functioning and independence in older adults. JAMA 2006, 296:2852 PMID: 17179463
  3. Iliffe S, Pealing L. Subjective memory problems. BMJ 2010; 340:c1425 PMID: 20304935
  4. Amariglio RE et al. Specific subjective memory complaints in older persons may indicate poor cognitive function. J Am Geriatr Soc 2011 Sep; 59:1612. PMID: 21919893 http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03543.x/abstract
  5. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Reid LM, Maclullich AM. Subjective memory complaints and cognitive impairment in older people. Dement Geriatr Cogn Disord. 2006;22(5-6):471-85. Review. PMID: 17047326
  7. Kryscio RJ et al Self-reported memory complaints: Implications from a longitudinal cohort with autopsies. Neurology 2014 Oct 7; 83:1359 PMID: 25253756 http://www.neurology.org/content/83/15/1359
  8. Salthouse TA, Mandell AR. Do age-related increases in tip-of-the-tongue experiences signify episodic memory impairments? Psychol Sci. 2013 Dec;24(12):2489-97. PMID: 24104505 Free PMC Article
  9. Kneisel K Mindfulness Training, Exercise May Not Help Subjective Cognitive Concerns. Stress, physical activity, and cognition may have complex relationship. MedPage Today December 13, 2022 https://www.medpagetoday.com/neurology/dementia/102220 - Lenze EJ, Voegtle M, Miller P et al Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults. A Randomized Clinical Trial. JAMA. 2022;328(22):2218-2229. PMID: 36511926
  10. Yeh T-S et al. Herpes zoster and long-term risk of subjective cognitive decline. Alzheimers Res Ther 2024 Aug 14; 16:180. PMID: 39138535 PMCID: PMC11323373 https://alzres.biomedcentral.com/articles/10.1186/s13195-024-01511-x - Taquet M, Dercon Q, Todd JA, Harrison PJ. The recombinant shingles vaccine is associated with lower risk of dementia. Nat Med. 2024 Jul 25. PMID: 39053634 https://www.nature.com/articles/s41591-024-03201-5