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Memory and Semantic Knowledge

Memory is the process of encoding, storing, and retrieving information in the brain. There are many aspects of memory. This chapter is concerned with examining the most clinically important aspects of memory, which are declarative, explicit, or conscious recollections. Patients, families, and clinicians often refer to declarative memory for recent episodic events as “short-term” memory; however, declarative memories are really long-term. Short-term (working) memory has a…

Language and Speech

Language is the usual “medium” for communication during mental status assessment. Like fundamental functions, the examiner must assess language early as disturbances can affect the rest of the examination. The first consideration is that language and speech are not the same. Language is the brain’s use of symbols for communication, and speech is the verbal motor expression of language. By this definition, language includes all symbolic…

Arousal, Attention, and Other Fundamental Functions

Fundamental functions, or disturbances of the “sensorium,” are a prerequisite to instrumental functions. They include arousal, basic attention, “mental control,” and psychomotor speed. The multimodal aspect of orientation to time and place, although dependent on memory, is also affected by attentional deficits, and is therefore discussed here. Alterations in fundamental functions decrease efficiency of cortical functioning, and hence affect the validity of the assessment of instrumental…

The Neurobehavioral History and Behavioral Observations

Obtaining a history and observing the patient are the first steps in a comprehensive mental status examination (MSX). Obtaining a history involves a skilled interview, a targeted cognitive history, and an evaluation of the patient’s personal background. Except for telephone encounters, the examiner should be able to make important observations of the patient’s behavior while conducting the interview and history taking. In addition to an excellent…

Essential Behavioral Neuroanatomy

The interpretation of the mental status examination depends on an understanding of behavioral neuroanatomy. As in the rest of neurology, the examination leads to localization, followed by a differential diagnosis of disease processes. This chapter gives the essentials necessary for localization of mental status abnormalities in the brain. It includes the different cortical lobes and the limbic structures that line the medial aspect of the cerebral…

Common Clinical Disorders Affecting Mental Status Testing

It is helpful to understand how the extended mental status evaluation is altered by the commonest mental status conditions seen in the clinical setting. These can be grouped into delirium, dementia, and depression. Focal cognitive disorders are listed in the subsequent chapter on the neuroanatomy of behavior. Delirium Delirium is the most common brain-behavior disorder and the most frequent behavioral manifestation of medical disorders or physiological…

Principles of Mental Status Testing

This chapter aims to provide the foundation for mental status testing. The first step is to establish the goal or purpose for assessing cognition. This guides the decision on what level of examination is needed and whether to refer for neuropsychological testing. Second, when performing the mental status examination (MSX), there are a number of principles or key factors to consider in giving tests to patients…

Memory Dysfunction in Alzheimer’s Disease and Other Causes of Mild Cognitive Impairment and Dementia

Here we will discuss the current understanding of memory to aid the clinician’s knowledge of how memory breaks down in Alzheimer’s disease, how that breakdown of memory is different from how memory declines in normal aging, and also how other causes of dementia may affect different aspects of memory. The four memory systems that are of clinical relevance are discussed: episodic memory, semantic memory, procedural memory,…

Screening for Memory Loss, Alzheimer’s Disease, and Dementia

Primary care physicians and other healthcare practitioners routinely screen for many diseases, including hypercholesterolemia, hypertension, and prostate and breast cancer, to mention a few. Yet Alzheimer’s disease, one of the most common disorders in older adults, is rarely screened for ( ). Interestingly, not only do most patients readily agree to memory screening, but also many are enthusiastic about having their memory treated as seriously as…

Cognitive Test and Questionnaire Forms, Instructions, and Normative Data for Evaluating Memory Loss, Alzheimer’s Disease, and Dementia

Screening for memory loss has become more and more common in both primary care and specialty practices. As discussed in Chapter 2 , there are a number of approaches to screening: Mental status tests: These tests are generally used to assess overall mental status and, as noted, can be used to screen for cognitive dysfunction. Single neuropsychological tests: Individual neuropsychological tests that can be used to…

Special Issues in Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start: Special Issues In Memory Loss, Alzheimer’s Disease, and Dementia Some Patients Do Not Want to Have Their Memory Evaluated Help patients understand that the goal is to improve their memory and allow them to continue doing the activities that they enjoy. Explain that there are a number of medications available that could help them. Some Patients Do Not Want You to Talk to Their…

Legal and Financial Issues in Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start: Legal And Financial Issues in Memory Loss, Alzheimer’s Disease, And Dementia Alzheimer’s advocacy groups can provide helpful and up-to-date information for families. Encourage your families to contact the Alzheimer’s Association ( www.alz.org , 800-272-3900) in the United States or similar organizations in other countries. Legal capacity is the capacity to make decisions and judgments necessary to sign legal documents, and depends upon the answers…

Life Adjustments for Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start: Life Adjustments for Memory Loss, Alzheimer’s Disease, and Dementia Issues in Mild Cognitive Impairment and Alzheimer’s Disease Dementia in the Very Mild and Mild Stages Patients with mild cognitive impairment and very mild Alzheimer’s disease dementia may be able to drive. A family member should ride in the passenger seat monthly while the patient is driving to help assure that the patient is driving…

Pharmacological Treatment of the Behavioral and Psychological Symptoms of Dementia

Quick Start: Pharmacological Treatment of the Behavioral and Psychological Symptoms of Dementia Pharmacological treatment of the behavioral and psychological symptoms of dementia should only be undertaken when one of the following situations is present: The symptoms are causing distress to the patient or caregiver. The symptoms are dangerous to the patient or others. There is a specific condition for which there is a known treatment that…

Nonpharmacological Treatment of the Behavioral and Psychological Symptoms of Dementia

Quick Start: Nonpharmacological Treatment Of The Behavioral And Psychological Symptoms Of Dementia Important Principles for Treating Behavioral and Psychological Symptoms of Dementia—The 3Rs: Reassure Let patients know that they will be cared for and their wishes will be respected. Reconsider Consider how things look from the patient’s point of view. Redirect Do not confront patients when they are wrong, frustrating, or delusional. Distract them by moving…

Caring for and Educating the Caregiver

Quick Start: Caring for and Educating the Caregiver Alzheimer’s is a disease that affects the entire family. Approximately 70% of patients with Alzheimer’s disease are cared for at home by a family member. Supporting the caregiver is vitally important. Listen to the caregiver. Educate the caregiver. Make sure the caregiver is taking care of his or her own health. Does the caregiver have a primary care…

Evaluating the Behavioral and Psychological Symptoms of Dementia

Quick Start: Evaluating the Behavioral and Psychological Symptoms of Dementia The behavioral and psychological symptoms of dementia The behavioral and psychological symptoms of dementia are usually the most difficult symptoms for patients and caregivers to manage. Symptoms usually assessed on the basis of interviews with patients and relatives include apathy, anxiety, depression, hallucinations, and delusions. Symptoms usually identified on the basis of observation of patient behavior…

Future Treatments of Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start: Future Treatments of Memory Loss, Alzheimer’s disease, and dementia Symptomatic and disease-modifying treatment Alzheimer’s disease can be treated either to improve symptoms and function or to slow disease progression. Symptomatic treatments work by altering neurotransmitter function. Disease-modifying treatments are aimed at slowing the loss of neurons. Disease-modifying treatments: amyloid plaques The amyloid cascade hypothesis describes how a build-up of β-amyloid can lead directly to…

Nonpharmacological Treatment of Memory Loss, Alzheimer’s Disease, and Dementia

Quick Start: Nonpharmacological Treatment of Memory Loss, Alzheimer’s Disease, and Dementia Nonpharmacological treatments to help memory loss can improve function equal to or greater than medication. External memory aids such as calendars, lists, and whiteboards can be helpful in keeping patients functional. It is important to keep the memory aid in the same place. Learning habits (using procedural memory) allow patients with even moderate Alzheimer’s disease…