From the Guidelines
For a 69-year-old patient presenting with short-term memory loss of 2 months duration, a comprehensive diagnostic workup should be initiated, including an expanded history focused on cognitive abilities, neurologic physical examination, assessment of risk factors, and general laboratory tests, as well as structural brain imaging with MRI, as recommended by the most recent guidelines 1. The workup should start with a detailed history focusing on the onset, pace, and nature of cognitive loss, including short-term memory and instrumental activities of daily living (ADLs) such as managing finances, cooking, driving, and using electronics. A neurologic physical examination should also be conducted to assess for any focal neurologic deficits.
- Key components of the initial assessment include:
- Obtaining a thorough medical history to identify potential risk factors for cognitive decline, such as cerebrovascular risk factors
- Reviewing medications that could contribute to cognitive impairment, such as anticholinergics or sedative hypnotics
- Assessing for psychiatric conditions that may mimic or contribute to cognitive symptoms
- Laboratory tests should be requested, including:
- Thyroid function tests
- Vitamin B12 level
- Homocysteine level
- Complete blood count with differential
- Complete metabolic panel (including calcium, magnesium, and liver function tests)
- Erythrocyte sedimentation rate and C-reactive protein
- Structural brain imaging is crucial, with MRI being the preferred modality, although a head CT can be used if MRI is contraindicated, as suggested by the guidelines 1. This approach is essential for identifying reversible causes of memory loss and for the early diagnosis of neurodegenerative diseases, allowing for timely intervention and potentially improving outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Appropriate Workup for Short-Term Memory Loss
The workup for a 69-year-old patient presenting with short-term memory loss (STM) of 2 months duration should include:
- A thorough history to identify potential causes of memory loss, such as intracranial hemorrhage, traumatic brain injury, or use of certain medications like ibuprofen 2
- Medication review to identify any medications that may be contributing to memory loss, such as ibuprofen 2
- Physical examination to identify any underlying medical conditions that may be contributing to memory loss
- Laboratory workup to rule out underlying medical conditions that may be contributing to memory loss, such as vitamin deficiencies or thyroid disorders
- Imaging studies, such as brain MRI, to identify any structural abnormalities that may be contributing to memory loss, such as cerebral amyloid angiopathy (CAA) 3
- Cognitive testing, such as the simplified Short-Term Memory recall Test (STMT), to assess the severity of memory impairment and identify potential pre-dementia states 4
- Screening for dementia using simple, validated tools, such as the MMSE and ADAS-Jcog, to guide care and identify specific causes contributing to memory loss 5, 4
Potential Causes of Short-Term Memory Loss
Potential causes of short-term memory loss include:
- Intracranial hemorrhage or traumatic brain injury 6
- Use of certain medications, such as ibuprofen 2
- Cerebral amyloid angiopathy (CAA) 3
- Vitamin deficiencies or thyroid disorders
- Pre-dementia states, such as mild cognitive impairment
Treatment Options
Treatment options for short-term memory loss depend on the underlying cause and may include:
- Discontinuation of offending medications, such as ibuprofen 2
- Treatment of underlying medical conditions, such as vitamin deficiencies or thyroid disorders
- Use of compounded methylcobalamin nasal spray to improve short-term memory function in patients with intracranial hemorrhage or traumatic brain injury 6
- Patient-centered, multidisciplinary team approach, including nonpharmacological and pharmacologic treatments, to manage cognitive impairment and preserve functional status 5