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Forgetfulness: It's Not Always What You Think

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Diagnosis

People who are worried about memory problems should see their doctor. If the doctor believes that the problem is serious, then a thorough physical, neurological, and psychiatric evaluation may be recommended. A complete medical examination for memory loss may include gathering information about the person's medical history, including use of prescription and over the counter medicines, diet, past medical problems, and general health. Because a correct diagnosis depends on recalling these details accurately, the doctor also may ask a family member for information about the person.

Tests of blood and urine may be done to help the doctor find any problems. There are also tests of mental abilities (tests of memory, problem solving, counting, and language). A brain CT scan may assist the doctor in ruling out a curable disorder. A scan also may show signs of normal age related changes in the brain. It may be necessary to have another scan at a later date to see if there have been further changes in the brain.

Alzheimer's disease and multi infarct dementia can exist together, making it hard for the doctor to diagnose either one specifically. Scientists once thought that multi infarct dementia and other types of vascular dementia caused most cases of irreversible mental impairment. They now believe that most older people with irreversible dementia have Alzheimer's disease.

Treatment

Even if the doctor diagnoses an irreversible form of dementia, much still can be done to treat the patient and help the family cope. A person with dementia should be under a doctor's care, and may see a neurologist, psychiatrist, family doctor, internist, or geriatrician. The doctor can treat the patient's physical and behavioral problems and answer the many questions that the person or family may have.

For some people in the early and middle stages of Alzheimer's disease, the drugs tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly known as Reminyl) are prescribed to possibly delay the worsening of some of the disease's symptoms. Another drug, memantine (Namenda), has been approved for treatment of moderate to severe AD. Doctors believe it is very important for people with multi infarct dementia to try to prevent further strokes by controlling high blood pressure, monitoring and treating high blood cholesterol and diabetes, and not smoking.

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