Elizabeth has been a friendly, alert member of the residence community since she moved in four years ago. But lately she has been letting her mailbox fill up, coming down late to dinner and missing hair appointments — two in a row. Her family is uneasy and residence staff is too. Is Mrs. Jones just getting older? Or do we need to have her memory checked?

Increasingly, the aging adult population is concerned about memory and brain function. We all want to remain healthy and vigorous throughout our lives, and we want that for our parents too. If seniors move into a retirement residence at 78 and enjoy life there, they may well still be there at 88. So a number of first-rate residences are finding more canes in the dining room and facing more issues of memory loss.

Today, treatments exist to delay cognitive decline and improve our memory function. Who would benefit from these treatments? What are the warning signs? And how should staff members or caregivers proceed if they suspect a memory problem?

Effective screening tools are available. Screening at-risk seniors and people with subjective complaints of memory loss can help select individuals for further evaluation, treatment and referral to a specialist, if needed. Caregivers and staff who know residents well may be aware of changes. They can work together with the family to make sure the whole picture is available.

Depression, both major and minor, is often the first behavioural sign of cognitive decline. Apathy, impulsivity or agitation could very well be related to the beginnings of cognitive impairment. Of course, such behaviour may also represent an acute medical condition or a side effect from medication. When such an overt change is recognized, a doctor’s evaluation is in order. Once the acute episode is resolved or stabilized, a cognitive assessment is highly recommended.

The more subtle, quietly progressive cognitive decline is harder, but valuable, to recognize. Subjective complaints of memory problems should always be acknowledged and discussed. The Alzheimer Society of Canada has developed a simple screening tool that helps you decide when to seek professional advice. It can also be used as a routine form of screening at an annual or semi-annual general health evaluation. Further, posting it at an information kiosk for seniors and their families will assist with identifying individuals in need of further assessment.

If any one of these items is a significant problem, or if two or more occur occasionally, I recommend referral to a health-care professional:
1. Difficulty performing familiar tasks
2. Problems with language
3. Disorientation in time and place
4. Poor or decreased judgment
5. Problems with abstract thinking
6. Tendency to misplace things
7. Changes in mood and behaviour
8. Changes in personality
9. Loss of initiative
10. Memory loss affecting day-to-day function

Of all the risk factors for memory decline, age is the single biggest overall. At age 65, two per cent of people will have a diagnosable cognitive problem. At age 75, about 10 per cent of people will be affected, and this number increases the higher the age. An equally large group of people at every age will have a minor form of memory impairment, called mild cognitive impairment (MCI). Identifying this group is very important to allow for optimal care of their cardiovascular health, thereby delaying further worsening of memory function.

I recommend incorporating an evaluation of cognitive status with the annual or semi-annual comprehensive health review. The Dementia Quick Screen (DQS) identifies those seniors in need of further assessment, based on age and the cardiovascular risk factors of each individual. For those identified by the DQS as at risk, cognitive assessment can proceed with either the Mini-Mental State Examination (MMSE), the clock-drawing task or the Montreal Cognitive Assessment (MoCA), providing a quantitative baseline of function before further assessment or treatment options are pursued. When further testing is needed, referral to a geriatrician may be needed.

What treatments do we have in 2009? Optimizing control of blood pressure, diabetes and lipids, enrolling in a regular exercise program, and engaging in both socially stimulating and “brain stimulating” activities are recommended for everyone with any amount of memory problems. For further information, contact the Alzheimer Society, www.alzheimer.ca, or see my own website.