As an SLP, you are an expert in treating cognitive-communication disorders. But how can you tell if your patient’s memory problem is due to normal forgetfulness, mild cognitive impairment, or dementia?
In this post, you’ll learn how to differentiate between the three and when it may be best to refer out.
For premade memory handouts and worksheets, check out our bestselling Adult Speech Therapy Starter Pack!
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Medical Conditions That Cause Memory Problems
Some medical conditions cause significant memory problems. Unlike dementia, treating the underlying condition in these cases may solve the memory problem.
Medical conditions that may cause memory problems include:
- Infections (UTI, meningitis, syphilis)
- Concussion from a fall
- Alcoholism
- Vitamin B-12 deficiencies
- Metabolic disorders (kidney failure)
- Hormone dysfunction (normal transition to menopause, thyroid issues)
- Tumors, blood clots, or infections in the brain
- Mental health issues (depression, anxiety, schizophrenia)
- Medication side effects
Forgetfulness
Some forgetfulness is a part of normal brain aging. Forgetfulness can also be caused by the medical conditions listed above.
With forgetfulness, symptoms like the ones below may happen once in a while:
- Forgetting which word to use
- Forgetting some details of an event
- Forgetting the name of an acquaintance
- Forgetting passwords
- Forgetting why they went into another room
- Forgetting where they parked their car
- Forgetting appointments
- Forgetting what day it is (but remembering later)
- Losing things
- Making a poor decision
- Taking longer to learn new things
These symptoms don’t affect a person’s ability to complete daily tasks. And they don’t come with difficulty learning or remembering new things.
Mild Cognitive Impairment (MCI)
Mild cognitive impairment (MCI) is sometimes, although not always, the transitional phase between normal aging and dementia. MCI is not normal aging.
Around one-third of people diagnosed with MCI will develop Alzheimer’s within five years. However, some will remain stable or even return to being neurologically intact.
Signs of Mild Cognitive Impairment
Unlike dementia, people with MCI can still do their daily activities and take care of themselves. Also unlike dementia, their personalities don’t change.
Signs of Mild Cognitive Impairment may include:
- Feeling confused doing familiar tasks
- Forgetting to go to events or appointments
- Losing things more often
- Having more trouble coming up with words than other people their age
- Close family and friends becoming worried about their memory
- Movement difficulties & problems with their sense of smell
Prevalence of MCI
According to the American Academy of Neurology’s Practice Guidelines, the prevalence of MCI worldwide is:
- 6.7% of people ages 60–64
- 8.4% of people ages 65–69
- 10.1% of people ages 70–74
- 14.8% of people ages 75–79
- 25.2% of people ages 80–84
Evidence-Based Treatments for MCI
1. Refer out
If your patient has one of the underlying medical conditions listed above, make sure it’s being managed by a physician or other specialist. Refer your patient to their doctor for a cognitive screen, blood test, or referrals to other specialists, as appropriate.
For these patients, getting the right treatment for their underlying medical condition can resolve the memory problem.
2. Cognitive training
An evidence review by the American Academy of Neurology found that cognitive training may improve select cognitive skills in people with MCI. These include increased use of internal strategies (self-talk, etc.) and improved scores on cognitive screens and assessments (MMSE, etc.)
While a 2022 systematic review and meta-analysis by Tulliani et al. found that cognitive remediation improved instrumental activities of daily living for patients with MCI and early-stage dementia
3. Exercise training program
There is also some evidence that physically exercising 2 times per week for 6 months may improve memory issues in patients with MCI. Encourage your patient to exercise or refer to physical therapy as needed.
4. Prevention
There are modifiable risk factors identified by the research that, if eliminated, can potentially prevent some cases of dementia.
Modifiable risk factors are thought to cause about 35% of dementia cases. These risk factors are:
- Less education (none or primary school only)
- Hypertension
- Obesity
- Hearing loss
- Smoking
- Depression
- Physical inactivity
- Social isolation
- Diabetes
Educate your patient on prevention, discuss how they can reduce some of their risk factors, and refer out to their physician and other specialists as needed.
Dementia
There isn’t a clear line between mild cognitive impairment and dementia. However, people with dementia have more severe memory issues, and it interferes with their ability to do their daily activities and take care of themselves.
As an SLP, your job is to assess cognitive-communication deficits and work with the medical team as they diagnose, plan for, and treat your patient’s memory issues.
Although dementia is irreversible, you have plenty of tools in your therapy toolkit to help improve patients’ safety, independence, and quality of life.
See ASHA.org’s Dementia Practice Portal for more information. And refer to our other articles and resources for help assessing and treating patients with dementia.
More Cognition Resources
The bestselling Adult Speech Therapy Starter Pack comes with handouts and worksheets to use with your speech therapy patients, including the Memory Pack, Problem Solving Pack, Aphasia Pack, Dysphagia Pack, and much more.
Reference
- American Speech-Language-Hearing Association (n.d.). Dementia (Practice Portal). Retrieved August, 3, 2023, from www.asha.org/Practice-Portal/Clinical-Topics/Dementia/.
- Macmillan, C. (2022, June 6). Mild Cognitive Impairment: It’s Not ‘Normal’ Aging > News. Yale Medicine. Retrieved August 3, 2023, from https://www.yalemedicine.org/news/mild-cognitive-impairment
- National Institute on Aging. (2018). Do Memory Problems Always Mean Alzheimer’s Disease? Retrieved August 3, 2023, from https://www.nia.nih.gov/health/do-memory-problems-always-mean-alzheimers-disease
- National Institute on Aging. (2020). Memory, Forgetfulness, and Aging: What’s Normal and What’s Not? Retrieved August 3, 2023, from https://www.nia.nih.gov/health/memory-forgetfulness-and-aging-whats-normal-and-whats-not
- National Institute on Aging. (2021). What Is Mild Cognitive Impairment? Retrieved August 3, 2023, from https://www.nia.nih.gov/health/what-mild-cognitive-impairment
- Petersen, R. C., et al. (2017). Practice guideline update: Mild cognitive impairment Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. American Academy of Neurology.
- Tulliani, N., et al. (2022). Efficacy of cognitive remediation on activities of daily living in individuals with mild cognitive impairment or early-stage dementia: a systematic review and meta-analysis. Systematic reviews, 11(1), 156. https://doi.org/10.1186/s13643-022-02032-0