Memory Loss in Elderly: When to See a Neurologist

If a mother is experiencing episodes of depression, she should consult a psychiatrist or a psychologist for evaluation and treatment?

Hello Doctor,
My mother is currently 82 years old.
She is generally healthy but has high blood pressure that is controlled with medication.
Last Friday, she went for rehabilitation (for her knee) and received heat therapy.
She experienced back pain and was advised to stretch her back, but unfortunately, she sustained a strain.
By late night, she developed a fever of 38.3 degrees Celsius and mild back pain.
We went to the Chang Gung Memorial Hospital emergency department, where blood and urine tests indicated a mild cold with no other issues.
However, due to severe back pain, she was administered half a dose of a morphine-like painkiller, which alleviated her condition.
On Monday, she visited the orthopedic outpatient clinic.
X-rays and other tests showed no abnormalities, confirming a muscle strain in her lower back.
She was prescribed pain relievers, anti-inflammatory medication, and gastric protectants.
Additionally, she saw an internist for a mild infection and was prescribed a three-day course of antibiotics.
After resting for two to three days at home, she felt somewhat better.
However, one evening, she wanted to take a bath and, without informing anyone or paying attention to her condition, got into the bathtub.
Due to her foot not being able to support her, she experienced immediate back pain and was unable to get up.
While being assisted out of the bathtub, she likely aggravated her back injury again.
At around 11 PM that night, we returned to the emergency department, where her back injury was confirmed.
Due to extreme pain, she received another dose of a morphine-like painkiller.
After applying cold compresses for two to three days, although there was slight improvement, she still experienced unbearable pain (most severe at night, making it impossible to lie flat, and painful while walking or sitting during the day).
Consequently, her sleep was very poor, averaging only one to two hours of fragmented sleep, with occasional daytime naps of one to two hours.
On Friday, she visited the orthopedic clinic again, where the source and location of her back pain were confirmed.
She received two injections (likely corticosteroids), which reduced her pain.
After switching to heat therapy, her condition significantly improved.
Although she couldn't sleep in bed at night, she managed to sleep for two to three hours in a massage chair.
During times of pain and fatigue, she would wake up to rest, and this pattern continued during the day.
Her energy and appetite also returned to normal.
However, some concerning incidents occurred in the past few days: On Tuesday morning around 9 AM, she suddenly did not recognize her home of 35 years, although my father and I did.
She remembered family photos.
After resting for a while, her memory returned to normal.
On Friday night around midnight, she experienced the same situation again.
This morning at 6 AM, everything seemed fine.
After breakfast, she went to the park for a walk.
Upon returning around 10 AM, she rested until 11:30 AM, but again did not recognize her home.
Although her memory of the morning activities was about 90% accurate, some parts were vague or distorted.
After resting, she returned to normal by lunchtime around noon.
Could you please help me understand what might be causing these episodes? Will they continue? Which specialty should we consult for further evaluation and treatment? I would greatly appreciate your guidance! Thank you very much! If you have time, please reply to my email! Thank you! Wishing you well!
Sincerely,
Wang Jiamin

Wang Jia Min, 50~59 year old female. Ask Date: 2014/05/18

Dr. Gao Chunde reply Neurology

Transient global amnesia (TGA) currently lacks a well-understood etiology.
Potential causes include transient discharges similar to those seen in epilepsy, migraine-related brain storms, transient cerebral ischemia, jugular venous reflux, or other factors.
It is essential to consult a neurologist for a thorough examination and to follow up with treatment based on any identified abnormalities.

Reply Date: 2014/05/18

More Info

Memory loss in the elderly can be a concerning issue, especially when it manifests suddenly or in unusual patterns. In the case of your 82-year-old mother, her recent experiences of temporary confusion and memory lapses following a series of physical health challenges warrant careful consideration.
From your description, it appears that your mother has been dealing with significant pain and discomfort due to a muscle strain in her back, which was exacerbated by her attempts to bathe independently. The use of strong pain medications, such as morphine, can also contribute to cognitive changes, including confusion and memory disturbances. Additionally, the stress of her physical condition, combined with poor sleep quality, can further impact cognitive function.
The episodes of not recognizing her home, despite being familiar with it for many years, could be indicative of a condition known as transient global amnesia (TGA). TGA is characterized by sudden, temporary episodes of memory loss that cannot be attributed to a more common neurological condition, such as a stroke or seizure. During these episodes, individuals may be unable to form new memories or recall recent events, but they typically retain their identity and personal history. The fact that your mother’s memory returned after a short period suggests that this could be a possibility.

However, it is essential to differentiate between TGA and other forms of cognitive impairment, such as dementia or delirium. Delirium, often caused by acute illness, medications, or infections, can lead to fluctuating levels of consciousness and confusion. Given that your mother had a mild infection and was on antibiotics, this could also be a contributing factor.
To determine the underlying cause of her memory issues, it would be prudent to consult a neurologist. A neurologist specializes in disorders of the nervous system and can conduct a thorough evaluation, including a detailed medical history, neurological examination, and possibly imaging studies like an MRI or CT scan to rule out any structural brain issues. They may also assess her cognitive function through standardized tests to evaluate memory, attention, and other cognitive domains.

In addition to seeing a neurologist, it may also be beneficial to consult with her primary care physician or a geriatrician. They can help manage her overall health, including her blood pressure and any other chronic conditions, while coordinating care with specialists.
In the meantime, ensuring that your mother has a stable environment, adequate hydration, and nutrition, as well as managing her pain effectively, can help improve her cognitive function. Encouraging regular sleep patterns and minimizing stressors in her environment may also be beneficial.

In summary, while the episodes of memory loss your mother is experiencing could be related to her recent health issues and medications, it is crucial to seek a professional evaluation to rule out more serious conditions. A neurologist will be able to provide the necessary assessments and guide you on the best course of action for her care.

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