1. Marijke Boers Church St Surgery April 2017
Memory Loss & The GP
Marijke Boers
Church St Surgery
April 2017

2. Role of the G. P. Is this NORMAL age related memory loss
OR…..Something Else…..
REFERENCE: Having a Senior Moment ?
Best Practice Journal of BPAC NZ WEBSITE
Number 36, Issue 23

3. We All Have Age Related Memory Loss
Starts in our 20’s
Accelerates from age 50
Neurones Reduce, Brain volume shrinks, synapses less efficient
Names/words/laying down new information
Genetics, hormones, other illness, environmental factors

4. 4 Types of Memory Episodic Memory- For significant events
Learning and recall Declines from middle age
Semantic Memory – factual and conceptual knowledge
Volume increases from middle age to young elderly, then declines
Procedural Memory- how to of skills and procedures… normally retained into late life
Working memory – learning new information, retaining and then manipulating it- eg- following a map, new person’s name, learning a new procedure… with age, the span often becomes shorter

5. Mild Dementia Frequently Misplaces Items
Forgets names , slow to recall them
Word finding difficulties
Forget recent events or newly learned information
Temporarily becomes lost, trouble understanding or following a map
Worries about memory loss. Friends and family are noticing
Forgets use of an item, or puts in wrong place
Forgets knowing someone
Begins to lose language skills
Loses sense of time, not sure what day it is
Working memory seriously impaired. Difficulty learning or remembering new information
Becomes easily disorientated or lost in familiar places
Little or now awareness of thinking /problem solving difficulties

6. 1. Confirm Memory and Thinking Problems
Memory Tests
Family Informant Questionnaire
(Helpful to have information from family and loved ones)
Consider repeating, different times, different questionnaires or versions of a questionnaire

7. 2. Rule out other causes Infections Heart or Breathing problems
Nutritional or Hormonal (eg Diabetes)
Mood or anxiety problems
…. So , MUST INCLUDE
A physical examination
Blood Tests

8. Once Cognitive Impairment Confirmed
Any REVERSIBLE Causes ?- FIX THOSE
Check Safety at home, driving, etc
See if patient needs support in their home- REFER to ICM or support services
If Mild, attend to diet, lifestyle, stimulation
If moderate, Consider CHOLINE ESTERASE INHIBITOR- or similar

9. CHOLINESTERASE INHIBITOR, BPJ Issue 30, P28
Acetyl Choline- important in brain for memory and other functions
Medication MAY be helpful in moderate or advanced Alzheimers…. Slows decline or even brief improvement
Does not prevent Decline, Sadly
Discuss Pros and Cons, consider side effects (Nausea , slowed heart rate, slow to wee…)
Side effects short lived, dose dependent
Monitor response carefully, get Specialist input , wean off when no longer helpful