Memory loss requires careful diagnosis, scientists say

Memory loss requires careful diagnosis, scientists say

A lengthy Justice Department report on President Biden’s handling of classified documents contained some startling assessments of his mental health and well-being.

Mr. Biden, 81, was an “elderly man with poor memory” and “diminished faculties” who “couldn’t remember when he was vice president,” said special counsel Robert K. Hur.

In recorded conversations in 2017, Mr. Biden was “often painfully slow” and “struggling to recall events and sometimes struggling to read and relay his notes in a notebook.” Mr. Biden was so impaired that a jury was unlikely to convict him, Mr. Hur said.

Republicans jumped in quickly, some calling the president unfit for office and asking for his departure.

But while the report disparaged Mr. Biden’s mental health, medical experts on Friday noted that his judgments were not based on science and that his methods bore no resemblance to what doctors use to assess possible cognitive impairment.

In its simplest form, the issue is one that doctors and family members have grappled with for decades: How do you know when an episode of confusion or a memory lapse is part of a serious decline?

The answer: “You don’t,” said David Loewenstein, director of the center for cognitive neuroscience and aging at the University of Miami Miller School of Medicine.

Diagnosis requires a series of sophisticated and objective tests that investigate several areas: different types of memory, language, executive function, problem solving and spatial attention skills.

The tests, he said, determine whether a medical condition is present and, if so, its nature and extent. Verbal obstacles are not evidence, said Dr. Loewenstein and other experts.

“Forgetting an event doesn’t necessarily mean there’s a problem,” said Dr. John Morris, a professor of neurology at Washington University in St.

Mr Hur, the special counsel, based his conclusions on a five-hour interview conducted over two days – two days after Hamas’ surprise attack on Israel – and a review of interviews with a ghost writer recorded in 2017 .

But to scientifically identify a memory problem requires doctors to assess the change in a person’s cognitive function over time and determine that its magnitude is sufficient to reduce the patient’s ability to perform ordinary activities, said Dr. Morris.

The best way to determine whether such a change has occurred is to compare results from a memory test today with results from a test taken five or 10 years ago, he added. If this does not happen, doctors may interview someone who knows the patient well – usually a close family member – to find out if there has been a fall.

Memory is only one aspect of cognition, noted Dr. Mary Ganguli, a professor of psychiatry, neurology and epidemiology at the University of Pittsburgh.

To make an accurate diagnosis, a geriatric psychiatrist may ask how long the patient has had problems with the ability to plan and organize, or express themselves. If the person forgets, what does he forget and when?

“We want to know what specific losses are observed, not just ‘memory,'” said Dr. Ganguly. “Was it a one-time thing when the person was tired or sick, or is it happening constantly and increasing in frequency?”

It is important to rule out other possible causes that could affect cognitive function, such as a stroke or head injury, or even the use of certain common medications, added Dr. Ganguly.

For example, a frequent culprit in memory lapses is diphenhydramine (sold as Benadryl and other brand names). People who take it chronically to fall asleep often become forgetful as a result. (Patients often tell her they take Tylenol at night, she said, but Tylenol PM actually contains diphenhydramine.)

Dementia has a distinctive pattern of memory loss that should not be confused with routine forgetfulness, added Dr. Ganguly. A person with dementia usually forgets recent events, such as what they had for breakfast, but remembers things from the distant past, such as a wedding day.

A detailed exam can take an hour, said Dr. Ganguli, and may also include interviews with family members. A family doctor can do a more abbreviated assessment, including quick memory tests like the Mini Mental State Examination or the Montreal Cognitive Assessment, known as the MCA.

In those tests, patients are asked the date and time and the location of the doctor’s office. They may be asked to draw a clock showing a specific time. They are told some words and, after a while, they are asked to repeat them.

To assess cognitive status, Dr. Loewenstein often administers a much longer, more probing series of objective tests. It’s a basic tenet of the field to never diagnose a patient you haven’t seen in a medical setting, he said.

Dr. Loewenstein said he was outraged by experts “who would have the audacity to make diagnoses saying, ‘Oh, this person went to the refrigerator and forgot why,’ or ‘Oh, they replaced someone’s name with another name when they had a other name”. things in their mind.”

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