Can memory problems be evaluated by psychiatry (psych) or neurology?

Memory Problems Can Be Evaluated by Both Psychiatry and Neurology

Both psychiatry and neurology specialists can evaluate memory problems, with the appropriate specialist depending on the suspected underlying cause and presenting symptoms. 1

When to Consider Psychiatric Evaluation

• Psychiatric evaluation is appropriate when memory problems are suspected to be related to psychiatric conditions such as depression, anxiety, or other mental health disorders 2
• Psychiatrists are well-equipped to evaluate memory complaints that may be associated with:
  • Major depression (which can present with pseudodementia) 3
  • Anxiety disorders that affect concentration and memory 4
  • Psychiatric disorders with personality disturbances 5
  • Sleep disorders affecting cognition 1

When to Consider Neurological Evaluation

• Neurological evaluation is appropriate when memory problems are suspected to be related to neurological conditions 1
• Neurologists typically evaluate memory complaints associated with:
  • Neurodegenerative disorders (Alzheimer's disease, other dementias) 3
  • Stroke or vascular cognitive impairment 2
  • Movement disorders (Parkinson's disease, Huntington's disease) 2
  • Traumatic brain injury or chronic traumatic encephalopathy 1
  • Epilepsy or seizure disorders 3

Decision Algorithm for Specialist Referral

Refer to Psychiatry When:

• Memory complaints are accompanied by prominent mood symptoms (depression, anxiety) 2
• Patient has a history of psychiatric illness 5
• Memory issues fluctuate with stress or emotional state 4
• No clear neurological signs or symptoms are present 4
• Memory problems appear to be subjective with normal performance on cognitive screening tests 3

Refer to Neurology When:

• Memory problems are accompanied by neurological symptoms (movement disorders, sensory changes) 1
• Cognitive decline is progressive and objective 3
• Abnormalities are detected on cognitive screening tests 1
• Patient presents with atypical cognitive abnormalities (aphasia, apraxia, agnosia) 1
• There is a family history of neurodegenerative disease 1

Role of Neuropsychological Testing

• Neuropsychological evaluation is recommended when office-based cognitive assessment is not sufficiently informative 1
• This comprehensive testing is valuable when:
  • Patient reports concerning symptoms but performs normally on brief cognitive tests 1
  • Results of cognitive testing are difficult to interpret due to complex clinical profile 1
  • There are confounding factors such as education level, language barriers, or sensory impairments 1
• Neuropsychological testing can help distinguish between psychiatric and neurological causes of memory problems 1

Interdisciplinary Approach

• In complex cases, collaboration between psychiatry and neurology may be optimal 1
• A comprehensive memory evaluation often benefits from:
  • Neurologist assessment for neurological examination and disease-specific testing 1
  • Psychiatric assessment for mood and behavioral symptoms 2
  • Neuropsychological testing for detailed cognitive profile 1
  • Geriatric assessment for older adults with multiple comorbidities 1

Important Considerations

• Memory complaints are common but only about 45% of patients with subjective memory complaints have objective memory deficits 5
• Delirium (acute confusion with impaired attention) must be distinguished from dementia (chronic cognitive decline with clear sensorium) 1
• Many patients with subjective memory complaints may have no detectable disease, but subjective memory loss can still be a predictor of future cognitive decline 3
• Both neurological disorders and psychiatric conditions can present with or exacerbate memory problems, making accurate diagnosis crucial 2

Pitfalls to Avoid

• Assuming all memory problems in older adults are due to dementia 3
• Failing to consider medication side effects as a cause of memory problems 3
• Overlooking psychiatric conditions that can mimic cognitive disorders 4
• Neglecting to perform comprehensive cognitive testing when brief screening is inconclusive 1
• Missing the bidirectional relationship between conditions like depression and neurological disorders 2