AAN recommends people 65+ be screened yearly for memory problems

by American Academy of Neurology

Credit: Public Domain

People with mild cognitive impairment have thinking and memory problems but usually do not know it because such problems are not severe enough to affect their daily activities. Yet mild cognitive impairment can be an early sign of Alzheimer's disease or other forms of dementia. It can also be a symptom of sleep problems, medical illness, depression, or a side effect of medications.

20 sept 2019--To help physicians provide the highest quality patient-centered neurologic care, the American Academy of Neurology (AAN) is recommending physicians measure how frequently they complete annual assessments of people age 65 and older for thinking and memory problems. This metric for yearly cognitive screening tests is part of an AAN quality measurement set published in the September 18, 2019, online issue of Neurology, the medical journal of the American Academy of Neurology.

A quality measure is a mathematical tool to help physicians and practices understand how often health care services are consistent with current best practices and are based on existing AAN guideline recommendations. Quality measures are intended to drive quality improvement in practice. Physicians are encouraged to start small using one or two quality measures in practice that are meaningful for their patient population, and measure use is voluntary.

"Since thinking skills are the most sensitive indicator of brain function and they can be tested cost-effectively, this creates an enormous opportunity to improve neurologic care," said author Norman L. Foster, MD, of the University of Utah in Salt Lake City and a Fellow of the American Academy of Neurology. "The American Academy of Neurology is recommending the measurement of annual cognitive screenings for everyone age 65 and older because age itself is a significant risk factor for cognitive decline and mild cognitive impairment is increasingly prevalent with older age. The measure complements past American Academy of Neurology quality measures released for Parkinson's disease, multiple sclerosis and stroke, and allows for a doctor to meet the measure with a recommended periodic three-minute cognitive test."

According to the 2018 AAN guideline on mild cognitive impairment, nearly 7 percent of people in their early 60s worldwide have mild cognitive impairment, while 38 percent of people age 85 and older have it.

The new AAN quality measurement set recommends doctors measure how often they conduct annual screenings to improve the recognition of mild cognitive impairment and allow for earlier intervention.

"We cannot expect people to report their own memory and thinking problems because they may not recognize that they are having problems or they may not share them with their doctors," said Foster. "Annual assessments will not only help identify mild cognitive impairment early, it will also help physicians more closely monitor possible worsening of the condition."

The new measurement set states that documenting mild cognitive impairment in a person's medical record can be invaluable in alerting other physicians and medical staff so that the best care is provided to that patient.

Early diagnosis can help identify forms of mild cognitive impairment that may be reversible, including those caused by sleep problems, depression or medications, and lead to treatments that can improve a person's quality of life such as correcting hearing loss and avoiding social isolation.

When mild cognitive impairment is not reversible and could develop into more severe forms of dementia like Alzheimer's disease, the quality measurement set recommends measuring how frequently people are given information about their condition as early as possible, so they can take steps to avoid exploitation, plan for their care and monitor their condition.

It is also important not to forget about family and caregivers. The measurement set also asks doctors to identify care partners to help describe symptoms. Doctors should quantify involvement with family and caregivers and provide them with information so that they too receive support and get access to services to help them cope if person's illness progresses and to improve their well-being.

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Journal information: Neurology 

Provided by American Academy of Neurology 

Studies: Memory declines faster in years closest to death

Two new studies published in the April 4 online issue of Neurology, the medical journal of the American Academy of Neurology, suggest that a person's memory declines at a faster rate in the last two-and-a-half years of life than at any other time after memory problems first begin. The second study shows that keeping mentally fit through board games or reading may be the best way to preserve memory during late life. Both studies were conducted by researchers at Rush University Medical Center.

05 april 2012--"In our first study, we used the end of life as a reference point for research on memory decline rather than birth or the start of the study," said study author Robert S. Wilson, PhD, study author and neuropsychologist at Rush University Medical Center in Chicago.

For the study, 174 Catholic priests, nuns and monks without memory problems had their memory tested yearly for six to 15 years before death. After death, scientists examined their brains for hallmarks of Alzheimer's disease called plaques and tangles.

The study found that at an average of about two-and-a-half years before death, different memory and thinking abilities tended to decline together at rates that were 8 to 17 times faster than before this terminal period. Higher levels of plaques and tangles were linked to an earlier onset of this terminal period but not to rate of memory decline during it.

The second study, also conducted by Wilson, showed that keeping mentally fit through board games or reading may be the best way to preserve memory during late life.

The study, which focused on mental activities, involved 1,076 people with an average age of 80 who were free of dementia. Participants underwent yearly memory exams for about five years. They reported how often they read the newspaper, wrote letters, visited a library and played board games such as chess or checkers. Frequency of these mental activities was rated on a scale of one to five, one meaning once a year or less and five representing every day or almost every day.

"The results suggest a cause and effect relationship: that being mentally active leads to better cognitive health in old age," said Wilson.

The results showed that people's participation in mentally stimulating activities and their mental functioning declined at similar rates over the years. The researchers also found that they could predict participants' level of cognitive functioning by looking at their level of mental activity the year before but that level of cognitive functioning did not predict later mental activity.

Provided by Rush University Medical Center

Weight loss improves memory: research

John Gunstad, an associate professor in Kent State University's Department of Psychology, and a team of researchers have discovered a link between weight loss and improved memory and concentration. The study shows that bariatric surgery patients exhibited improved memory function 12 weeks after their operations.

19 april 2011--The findings will be published in an upcoming issue of Surgery for Obesity and Related Diseases, the Official Journal of the American Society for Metabolic and Bariatric Surgery. The research report is also available online at www.soard.org/article/S1550-7289(10)00688-X/abstract.

"The initial idea came from our clinical work," Gunstad said. "I was working at Brown Medical School in Rhode Island at the time and had the chance to work with a large number of people who were looking to lose weight through either behavioral means or weight loss surgery."

Gunstad said he kept noticing that these patients would make similar mistakes. "As a neuropsychologist who is focused on how the brain functions, I look for these little mental errors all the time," Gunstad explained.

The research team studied 150 participants (109 bariatric surgery patients and 41 obese control subjects) at Cornell Medical College and Weill Columbia University Medical Center, both in New York City, and the Neuropsychiatric Research Institute in Fargo, N.D. Many bariatric surgery patients exhibited impaired performance on cognitive testing, according to the study's report.

The researchers discovered that bariatric surgery patients demonstrated improved memory and concentration 12 weeks after surgery, improving from the slightly impaired range to the normal range.

"The primary motivation for looking at surgery patients is that we know they lose a lot of weight in a short amount of time, so it was a good group to study," Gunstad said. "This is the first evidence to show that by going through this surgery, individuals might improve their memory, concentration and problem solving."

Gunstad thinks the study is reason for optimism. "One of the things about obesity, relative to other medical conditions, is that something can be done to fix it," Gunstad said. "Our thought was, if some of these effects are reversible, then we're really on to something - that it might be an opportunity for individuals who have memory or concentration problems to make those things better in a short amount of time. And that's what we found."

The team is following study participants for two years. They tested subjects before surgery, 12 weeks after surgery and one year after surgery, and will also test at the two-year mark.

Gunstad was the principal investigator for the team, which included Gladys Strain, Ph.D., of Cornell Medical College in New York City; Michael Devlin, M.D., of Weill Columbia University Medical Center in New York City; Rena Wing, Ph.D., and Ronald Cohen, Ph.D., of the Warren Albert Medical School of Brown University in Providence, R.I.; Robert Paul, Ph.D., of the University of Missouri-St. Louis in St. Louis, Miss.; and Ross Crosby, Ph.D., and James Mitchell, M.D., of the Neuropsychiatric Research Institute in Fargo, N.D.

Gunstad wasn't surprised by the study's findings. "A lot of the factors that come with obesity – things such as high blood pressure, type 2 diabetes and sleep apnea - that might damage the brain are somewhat reversible," Gunstad said. "As those problems go away, memory function gets better."

The team's next project will examine whether people who experience behavioral weight loss see the same effects as those who have had bariatric surgery. Gunstad said he expects to see similar results.

"One of the things we know is that as individuals become more cardiovascular fit and their heart health gets better, their brain health also improves," Gunstad added. "Even if we take young adults and put them through an exercise program, their memory and their concentration get better by the end of the program."

Provided by Kent State University

High cholesterol and blood pressure in middle age tied to early memory problems

Middle-age men and women who have cardiovascular issues, such as high cholesterol and high blood pressure, may not only be at risk for heart disease, but for an increased risk of developing early cognitive and memory problems as well. That's according to a study released today that will be presented at the American Academy of Neurology's 63rd Annual Meeting in Honolulu April 9 to April 16, 2011.

22 feb 2011--For the study, 3,486 men and 1,341 women with an average age of 55 underwent cognitive tests three times over 10 years. The tests measured reasoning, memory, fluency and vocabulary. Participants received a Framingham risk score that is used to predict 10-year risk of a cardiovascular event. It is based on age, sex, HDL cholesterol, total cholesterol, systolic blood pressure and whether they smoked or had diabetes.

The study found people who had higher cardiovascular risk were more likely to have lower cognitive function and a faster rate of overall cognitive decline compared to those with the lowest risk of heart disease. A 10-percent higher cardiovascular risk was associated with poorer cognitive test scores in all areas except reasoning for men and fluency for women. For example, a 10 percent higher cardiovascular risk was associated with a 2.8 percent lower score in the test of memory for men and a 7.1 percent lower score in the memory test for women.

Higher cardiovascular risk was also associated with a 10-year faster rate of overall cognitive decline in both men and women compared to those with lower cardiovascular risk.

"Our findings contribute to the mounting evidence for the role of cardiovascular risk factors, such as high cholesterol and blood pressure, contributing to cognitive problems, starting in middle age," said study author Sara Kaffashian, MSc, with INSERM, the French National Institute of Health & Medical Research in Paris. "The study further demonstrates how these heart disease risk factors can contribute to cognitive decline over a 10-year period."

Provided by American Academy of Neurology

Older adults experience 'destination amnesia'
...and over-confidence with false beliefs


Older adults are more likely to have destination memory failures – forgetting who they've shared or not shared information with, according to a new study led by Baycrest's Rotman Research Institute.

03 sept 2010--It's the kind of memory faux pas that can lead to awkward or embarrassing social situations and even miscommunication in the doctor's office. Ironically, after making these memory errors older adults remain highly confident in their false beliefs.

The study appears online, ahead of print publication, in the Online First Section of Psychology and Aging.

"What we've found is that older adults tend to experience more destination amnesia than younger adults," said lead investigator and cognitive scientist Dr. Nigel Gopie, who led the study with internationally-renowned experts in memory and attention, Drs. Fergus Craik and Lynn Hasher.

"Destination amnesia is characterized by falsely believing you've told someone something, such as believing you've told your daughter about needing a ride to an appointment, when you actually had told a neighbour."

Why are older adults more prone to destination memory failures? The ability to focus and pay attention declines with age, so older adults use up most of their attentional resources on the telling of information and don't properly encode the context (ie. who they are speaking to) for later recall.

"Older adults are additionally highly confident, compared to younger adults, that they have never told people particular things when they actually had," added Dr. Gopie. "This over-confidence presumably causes older adults to repeat information to people."

A critical finding in the study is that destination memory is more vulnerable to age-related decline than source memory. Source memory is the ability to recall which person told you certain information.

In the research, 40 students from the University of Toronto (ages 18 - 30) and 40 healthy older adults from the community (ages 60 - 83) were divided into two experimental groups. The first experiment measured destination memory accuracy and confidence: requiring the individual to read out loud 50 interesting facts to 50 celebrities (whose faces appear on a computer screen), one at a time, and then remember which fact they told to which famous person. For example, "a dime has 118 ridges around it" and I told this fact to Oprah Winfrey.

The second experiment measured source memory accuracy and confidence: requiring the individual to remember which famous person told them a particular fact. For example, Tom Cruise told me that "the average person takes 12 minutes to fall asleep".

In the first experiment for destination memory accuracy, older adults' performance was 21% worse than their younger counterparts.

In the second experiment for source memory accuracy, older and younger adults performed about the same (60% for young, 50% for old) in recollecting which famous face told them a particular fact.


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The study was funded by the Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, U.S. National Institute on Aging, and a Baycrest Jack and Rita Catherall Award.

The study follows an earlier one published last year in Psychological Science by Dr. Gopie (Baycrest's Rotman Research Institute) and Dr. Colin M. MacLeod (University of Waterloo). That one looked at disrupted destination memory in a single age group – university-aged students.

Elderly at risk of memory trouble after surgery


People 60 and older who undergo elective surgery may be at higher risk of lasting memory problems, U.S. researchers said on Wednesday.
They said people 60 and older who have major surgeries such as joint replacements or hysterectomies are more likely to have cognitive problems after surgery.
And those who do are more likely to die in the first year after their surgery.
"We have known that patients undergoing heart surgery are at risk for cognitive dysfunction -- problems with memory, concentration, processing of information -- but the effects of non-cardiac surgeries on brain function are not as well-understood," said Dr. Terri Monk, an anesthesiologist at Duke University Medical Center, whose study appears in the journal Anesthesiology.
Monk led a team that examined hospital discharge records of 1,064 patients aged 18 and older who underwent testing for memory and cognitive function before surgery, at the time of discharge from the hospital and three months later.
They were put into three age groups: young (18-39), middle-aged (40-59) and elderly (60 and older). The groups were all of similar size.
Three months after surgery, cognitive deficits occurred in 12.7 percent of elderly patients, compared with just 5.7 percent of those in the young group or 5.6 percent in the middle-aged group.
The study suggests that overall, some 30 to 41 percent of adult patients undergoing major non-cardiac surgery have some form of memory or processing problem when they are discharged, but most people recover after three months.
But those 60 and older were more than twice as likely to still have problems three months after surgery. And those that had problems were more likely to die within the first year after surgery.
It is not clear why some patients suffer these problems, but it may be that surgery and anesthesia cause swelling in the brain that can affect the patient's ability to learn, retain or remember information, Monk said in a statement.
She said the study suggests the elderly may be predisposed to cognitive problems after major surgery. And knowing this might help doctors devise better strategies to prevent the effects of surgery and anesthesia on the aging brain.