Memory problems are a common experience for the elderly. Causes are many and can range
from mild forgetfulness of normal aging to a progressive dementia such as Alzheimer's disease.

Memory problems can occur one of two ways:

1.	Alone
2.	With problems in other areas such as language (aphasia), carrying out motor tasks (apraxia), recognizing objects (agnosia), planning and organizing complex tasks (executive functioning). If one or more of these occur with a memory problem the person has a DEMENTIA.
	Dementia is a disease and not part of normal aging.

Evaluation by a doctor can determine the cause of a memory problem. This should include a careful history, examination of mental state (including memory), a physical exam, and laboratory studies. It may also include CAT scan or NM, more detailed cognitive testing, or other studies.

Causes can include:
1. Normal aging - mild short-term forgetfulness, less speed of processing things, does not
interfere with normal functioning, usually does not get worse. Person is aware of problem.

2. A medical problem such a low thyroid (hypothyroidism), low vitamin B-12, or side effect of
many medications, especially if a person is on many at once.

3. Alzheimer's disease -- the most common cause of severe memory loss in the elderly. 5-6% at age 65 and rapidly increases in frequency as people get older.
Brain cells die over time--first in the area most strongly associated with memory "7-12" year course, often slow. Not just memory but other symptoms listed above plus: other changes may include: personality change, poor insight, depression, seeing or hearing things (hallucinations), false and often paranoid beliefs (delusions), aggression, sleep changes.
Later: gait problems, bladder/bowel control, fully dependent for care.

Does not show up on labs or CAT scan (they rule out other causes). But if typical symptoms, can be diagnosed with 85-95% accuracy.

No cure yet but there are some treatments for memory and other symptoms. Also support and
guidance for patient and caregiver are crucial.

For memory symptoms (modest effect): Aricept and Cognex (FDA approved), ?high dose vitamin E, ? estrogen, ????Ginkgo-- of course, don't start any medicine without first talking to your doctor!

For other symptoms: Medicines for treating depression, hallucinations, false beliefs, aggression,
sleep problems. Due to side effects, used only if other interventions not successful.

New drugs to treat these symptoms as well as to delay or prevent AD being studied. Estrogen
replacement may help to delay or prevent AD, nonsteroidals like ibuprofen being studied.

4. Dementia from strokes (ministrokes, "hardening of arteries").
Can be occur after major stokes. Can occur from very small strokes over time without other symptoms. Can mimic AD, including progression. often neurologic changes (e.g. weak on one side) or strokes on CAT or NM Risk factors: hypertension, cardiovascular disease, diabetes, high cholesterol
Treatment: treat the risk factors, blood thinner Eke aspirin if no contraindication

5. Depression common in the elderly. Can have memory problems, but also other symptoms like low mood, sleep or eating changes (esp. decreased), suicidal thoughts, low energy. Often also present with another dementia. Treated with therapy and/or antidepressants.