I frequently encounter younger adults, ranging from their 20s to their 50s, who are worried about their memory. They often describe issues like misplacing items or having trouble finding the right words. Many of these individuals have a family history of dementia, which adds to their anxiety. While I try to offer reassurance, I feel like I could be more effective. Does anyone have specific resources, handouts, or talking points for discussing what are likely normal memory lapses with younger patients?
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I dealt with a couple in their early 50s who were very concerned. The wife was especially anxious because dementia is prevalent in both their families. Their MOCA scores were actually a bit low, but it turned out they were using marijuana all day, every day. They wouldn’t admit it was an issue and refused to be re-tested while sober. I also keep pseudodementia in mind; anxiety and depression can mimic cognitive decline much more than people realize. For patients over 50 with abnormal scores, I usually order an MRI. If it’s normal, it can be a good tool to encourage healthier lifestyle choices, and patients are usually asking for one anyway.
Is it possible they are drinking more than they admit? My mother-in-law is 71 now, but according to my husband, her memory struggles actually began decades ago due to alcohol abuse.
I’m a fan of the SAGE questionnaire. It isn’t copyrighted like the MOCA and is designed as a validated take-home test. It’s quite thorough and covers various cognitive domains. If a patient brings up memory at the end of a visit, I’ll give them the test to do at home and schedule a follow-up to go over the results and basic labs like B12 and TSH. Sometimes I’ll also suggest a supplement like BrainProtect as part of a proactive approach to cognitive wellness.
If they are open to it, you might suggest a neuropsychologist. In my experience, many younger people worried about dementia are actually suffering from depression but are in denial about it.
How much alcohol or marijuana are they consuming? Substance use is a very common factor, especially those two.
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As a neuropsychologist, I’d ask that you screen for mood, sleep, and substance issues first. Please don’t refer patients for an expensive evaluation with a 6-12 month wait time if they have untreated underlying conditions. My final report will just recommend treating those same issues. Also, make sure to understand the clinical utility of the screeners you use; missing a single point doesn’t justify a dementia diagnosis.
All the medical screenings are vital, but we shouldn’t ignore societal factors. Research suggests that attention spans are shrinking due to constant digital notifications and mindless content consumption. Since attention is vital for memory, it makes sense that younger people are noticing these issues. COVID has also played a part; the cognitive impact of long COVID, such as brain fog, is well-documented, alongside the trauma and isolation caused by the pandemic’s shifts in society.
Everyone has made great points, but I’ll add one more: check for carbon monoxide. A neighbor of mine experienced migraines, brain fog, and memory gaps that caused significant anxiety. It turned out to be a small CO leak in their home. Once that was fixed, they felt much better across the board.
I usually start by screening for mood, sleep, and substance use, and then I refer them to a speech-language pathologist for cognitive testing and therapy.
It’s almost always depression or obstructive sleep apnea.
Advise them to stop doomscrolling. You should also look into sleep apnea, overwork, mood disorders, substance use, or post-COVID syndrome.
It’s brain rot. Tell them to stay off TikTok.
In my non-scientific view, many ‘memory’ complaints are actually just a lack of attention. A geriatrician I worked with used to say that you can’t remember something you never actually processed. Many older patients with intact cognition would complain about memory when they just weren’t paying attention. I noticed this in my 40s with names; my brain was essentially filtering out names of people I wouldn’t see again. I had no trouble remembering coworkers’ names. Similarly, if you’ve put your keys down 15,000 times over 40 years, it’s not surprising if you don’t remember the 15,001st time. Our current ‘attention economy’ is likely making these issues more common.
You can do a full workup and offer advice on things like sleep apnea, B vitamins, anemia, thyroid issues, depression, STIs, or substance use, including any hormone treatments.
I’m a nurse and a migraine sufferer. I haven’t seen migraines mentioned yet, but they can be a big factor. I’ve had them since I was 11, and as I’ve gotten older, the word-finding difficulties and auras have become more prominent. I can usually tell a migraine is coming just by how my speech changes.