Impaired Memory

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of memory loss

Specific difficulties: ‍remembering namesremembering appointments

Onset: ‍gradualsuddenprogressive

Impact on daily activities is ‍minimal

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍confusion

‍disorientation

‍difficulty concentrating

‍mood changes

‍anxiety

‍depression

‍difficulty finding words

‍getting lost in familiar places

‍aphasia

‍apraxia

‍agnosia

‍agitation

‍irritability

‍social withdrawal

‍apathy

‍misplacing items

‍difficulty planning or solving problems

‍sleep disturbances

‍loss of appetite

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍cardiovascular risk factors

‍smoking

‍alcohol use

no history of: ‍Alzheimer's disease, ‍dementia, ‍stroke, ‍head trauma, ‍thyroid problems, ‍vitamin B12 deficiency, ‍depression

no use of: ‍sedatives, ‍antidepressants, ‍antihistamines, ‍new medication

no family history of: ‍dementia, ‍Alzheimer's disease





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Age-related cognitive decline ‍likelysuspectedpossible

DDx: age-related cognitive decline, Neurocognitive disorder, Alzheimer's disease, vascular dementia, mixed dementia, Lewy body dementia, frontotemporal dementia, normal pressure hydrocephalus, medication side effect, depression, anxiety disorders, sleep disorders, substance use disorders, vitamin B12 deficiency, thyroid dysfunction, hypercalcemia, neurosyphilis, HIV-associated neurocognitive disorder, traumatic brain injury, brain tumors, seizure disorders, multiple sclerosis, Parkinson's disease, chronic liver disease, chronic kidney disease, electrolyte imbalances, heavy metal poisoning, alcohol-related brain damage, autoimmune encephalitis, post-concussion syndrome, long Covid





PLAN:

Investigations:

- Mini-mental state exam

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍calcium, ‍albumin, ‍TSH, ‍B12, ‍HIV, ‍syphilis

- CT scan of the brain

- MRI of the brain

- Lumbar puncture

Treatments:

- Reassessment of medications

- Stop medications that may contribute to condition (e.g. anticholinergics, benzodiazepines, opioids, antihistamines, antipsychotics)

- Dispill packaging

- Avoidance of alcohol

- ‍Cholinesterase inhibitors

- ‍NMDA receptor antagonists

- ‍Antidepressants

- ‍Sedatives

- Cognitive stimulation therapy

- Occupational therapy for cognitive assessment

- Occupational therapy for functional assessment

- Home safety assessment

- Driving assessment

Further care:

- Complete history with family members

- Referral to geriatrician

- Referral to neurologist

- Referral to neuropsychologist

- Referral to social worker

- Follow-up in ‍ ‍weeksmonths

- Return if memory loss worsens or if new symptoms develop such as confusion, personality changes, or difficulty with daily activities