Memory Loss,Cognitive Dysfunction: The Facts

There are a number of defined clinical "syndromes" that involve memory loss and/or cognitive impairment. Some of these are clearly treatable with proper diagnosis and therapy. Others are currently not treatable and only palliative measures can be applied at present. Clinically, there appears to be no difference between these "organic" brain disorders and other types of "age-related"memory impairment other than subjective degree. Whether this clinical lack of difference is real and important has yet to be determined by laboratory ("academic or evidence-based") medical science. In the absence of clear biochemical (lab testing) or structural (CT, MRI, PET) abnormalities, most complaints of memory disturbance are said to be "benign" and of little clinical significance. However, many patients with progressively serious memory problems begin in this fashion and progress over time, sometimes quite rapidly. When it becomes evident that the "mild" problems previously reported and ignored are progressing repeated biochemical and structural testing commonly remains "normal" or non-specific. Among the clearly treatable and potentially reversible forms of memory loss, cognitive dysfunction and dementia are metabolic conditions (such as hypothyroidism, vitamin B12 deficiency or liver disease), over medication with sedatives, pain relieving and psycho-tropic pharmaceuticals, depression, and brain space occupying lesions (sub-dural hematoma, brain tumor).1 It should be assumed that any reasonably skilled clinician would evaluate every patient complaining of memory loss, cognitive decline or dementia for these potentially treatable conditions. Once diagnosed and treated correctly any cognitive problems related to an underlying treatable medical or surgical condition should clear up. As for the less treatable forms of memory loss, cognitive decline and dementia there are still actions that can be taken to potentially aid this unfortunate situation. Perhaps the most widely recognized of the "non-curable" causes of memory loss, cognitive decline and dementia is Alzheimer Disease (AD).


1. Beal MF, Richardson EP Jr, Martin J. Alzheimer's Disease and Other Dementias. In [eds: Isselbacher AB, Braunwald E, Wilson JD, et al] Harrison's Principles of Internal Medicine. 1994;1:2269-2272.