Clinical conditions and memory complaints in outpatient elderly

Magaldi, Regina Miksian; Busse, Alexandre Leopold; Coelho, Venceslau Antonio; Apolinário, Daniel; Lopes, Leonardo da Costa; Satomi, Erika; Kasai, Juliana Yumi Tison; Jacob Filho, Wilson

doi:10.1590/S1980-57642009DN20400015

Abstract

Memory complaints are common in elderly, and may be associated with many clinical problems. Objective: To identify clinical conditions and possible factors related to memory complaints in elderly outpatients presenting at a tertiary unit. Methods: Patients with memory complaints and normal cognitive screening tests were submitted to clinical and laboratorial testing. Radiological evaluation was performed as needed for diagnosis. Results: One hundred and seventy-seven subjects were initially evaluated, 12 were excluded because of poor and inconsistent memory complaints. Of the remainder, seventeen had criteria for dementia diagnosis. Ninety-two (55.4%) had one or more comorbid conditions possibly related to their complaints. Major depression was present in 26.0%. Sixteen patients (9.6%) had vitamin B12 deficiency, 8 were in use of inappropriate medications, and 7 (4.2%) had hypothyroidism. Other conditions diagnosed were: generalized anxiety disorder, obstructive sleep apnea syndrome, hyperparathyroidism, normal pressure hydrocephalus. Three patients had severe hearing loss (in 22 with hearing complaints); one had severe visual impairment (in 22 with visual complaints). Conclusions: Comprehensive evaluation was able to identify treatable conditions possibly related to memory complaints.

Key words:
memory; cognition; dementia; elderly

Resumo

Queixas de memória são comuns em idosos, podendo estar associadas a diversos problemas clínicos. Objetivo: Identificar condições clínicas e fatores relacionadas a queixas de memória em pacientes idosos encaminhados a um serviço terciário. Métodos: Pacientes com queixas de memória e testes de rastreio cognitivo normal foram submetidos a avaliação clínica detalhada e testes laboratoriais, além de avaliação radiológica quando necessário para o diagnóstico. Resultados: Cento e setenta e sete pacientes foram inicialmente avaliados, sendo 12 excluídos devido a queixas frustras e inconsistentes de memória. Dos restantes, 17 preenchiam critérios clínicos para diagnóstico de demência. Noventa e dois (55,4%) apresentavam uma ou mais condições clínicas possivelmente relacionadas às queixas. Depressão maior estava presente em 26%. Dezesseis pacientes (9,6%) tinham deficiência de vitamina B12, 8 estavam em uso de medicações inapropriadas e 7 (4,2%), hipotireoidismo. Outras condições diagnosticadas foram: transtorno de ansiedade generalizada, síndrome da apnéia obstrutiva do sono, hiperparatireoidismo e hidrocefalia de pressão normal. Três pacientes apresentavam hipoacusia grave (em 22 com queixas auditivas), e 1 apresentava perda visual grave (em 22 com queixas visuais). Conclusões: Avaliação detalhada pode identificar diversas condições clínicas tratáveis, possivelmente relacionadas às queixas de memória.

Palavras-chave:
memória; cognição; demência; idoso

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References

¹
Mitchell AJ. The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. Int J Geriatr Psychiatry 2008; 23:1191-1202.
²
Jungwirth S, Fischer P, Weissgram S, Kirchmeyr W, Bauer P, Tragl KH. Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. J Am Geriatr Soc 2004;52:263-268.
³
Bassett SS, Folstein MF. Memory complaint, memory performance, and psychiatric diagnosis: a community study. J Geriatr Psychiatry Neurol 1993;6:105-111.
⁴
Abdulrab K, Heun R. Subjective Memory Impairment. A review of its definitions indicates the need for a comprehensive set of standardised and validated criteria. Eur Psychiatry 2008;23:321-330.
⁵
Minett TS, Da Silva RV, Ortiz KZ, Bertolucci PH. Subjective memory complaints in an elderly sample: a cross-sectional study. Int J Geriatr Psychiatry 2008;23:49-54.
⁶
Dartigues JF, Fabrigoule C, Letenneur L, Amieva H, Thiessard F, Orgogozo JM . Epidemiology of memory disorders. Therapie 1997;52:503-506.
⁷
Coley N, Ousset PJ, Andrieu S, Matheix Fortunet H, Vellas B. Memory complaints to the general practitioner: data from the GuidAge study. J Nutr Health Aging 2008;12:66S-72S.
⁸
Clarfield AM. Reversible dementia--the implications of a fall in prevalence. Age Ageing 2005;34:544-545.
⁹
Hejl A, Høgh P, Waldemar G. Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neurol Neurosurg Psychiatry 2002;73:390-394.
¹⁰
Brucki S, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do Mini Exame do estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹¹
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychosocial function. JAMA 1963;185:94-99.
¹²
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
¹³
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. Washington: American Psychiatric Association; 1994.
¹⁴
McKhannG, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
¹⁵
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.
¹⁶
Morris JC. Mild Cognitive Impairment Is Early-Stage Alzheimer Disease - Time to Revise Diagnostic Criteria. Arch Neurol 2006;63:15-16.
¹⁷
Ganguli M, Dodge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type - An epidemiologic study. Neurology 2004;63:115-121.
¹⁸
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
¹⁹
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256:240-246.
²⁰
Portet F, Ousset P J, Visser P J, et al. (EADC) European Consortium on Alzheimer's disease procedure. Report of the MCI working group of the critical review of the concept and new diagnostic Mild Cognitive Impairment in medical practice. J Neurol Neurosurg Psychiatry 2006;77:714-718.
²¹
Reisberg B, Prichep L, Mosconic L, et al. The pre-mild cognitive impairment, subjective cognitive impairment stage of Alzheimer's disease. Alz Dem 2008;4:S98-S108.
²²
Barry PP, Moskowitz MA. The diagnosis of reversible dementias in the elderly: a critical review. Arch Intern Med 1988;148: 1914-1918.
²³
Weytingh MD, Bossuyt PMM, van Crevel H. Reversible dementia: more than 10% or less than 1%? J Neurol 1995;242: 466-471.
²⁴
Clarfield AM.The decreasing prevalence of reversible dementias: an updated meta-analysis. Arch Intern Med 2003;163: 2219-2229.
²⁵
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of Potentially Reversible Dementias in a Dementia Outpatient Clinic of a tertiary University-affiliated Hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.
²⁶
Burke D, Sengoz A, Schwartz R. Potentially reversible cognitive impairment in patients presenting to a memory disorders clinic. J Clin Neurosci 2000;7:120-123.
²⁷
Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K. Depressive Symptoms, Vascular Disease, and Mild Cognitive Impairment. Findings From the Cardiovascular Health Study. Arch Gen Psychiatry 2006;63:273-280.
²⁸
Hudon C, Belleville S, Gauthier S. The association between depressive and cognitive symptoms in amnestic mild cognitive impairment. Int Psychogeriatr 2008;20: 710-723.
²⁹
Ellison JM, Harper DG, Berlow Y, Zeranski L. Beyond the "C" in MCI: Noncognitive Symptoms in Amnestic and Non-amnestic Mild Cognitive Impairment. CNS Spectr 2008; 13:66-72.
³⁰
Lin MY, Gutierrez PR,. Stone KL, et al. Vision Impairment and Combined Vision and Hearing Impairment Predict Cognitive and Functional Decline in Older Women. J Am Geriatr Soc 2004;52:1996-2002.
³¹
Lopes LC, Magaldi RM, Gândara MER, Reis ACB, Jacob-Filho W. Prevalence of Hearing Impairment in Patients with Mild Cognitive Impairment. Dement Neuropsychol 2007;3:253-259.
³²
Andrès E, Loukili N H, Noel E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004;171:251-259.
³³
Lindenbaum J, Rosenberg IH, Wilson PWF, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2-11.
³⁴
Hin H, Clarke R, Sherliker P, et al. Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. Age Ageing 2006;35:416-422.
³⁵
Manciet G, Dartigues JF, Decamps A, et al. The PAQUID Survey and Correlates of Subclinical Hypothyroidism in Elderly Community Residents in the South West of France. Age Ageing 1995;24:235-241.
³⁶
Knopman AU, Petersen RC, Cha RH, Edland SD, Rocca WA. Incidence and causes of nondegenerative nonvascular dementia: a population-based study. Arch Neurol 2006;63:218-221.
³⁷
Moore AR, O'Keeffe ST. Drug-induced cognitive impairment in the elderly. Drugs Aging 1999;15: 5-28.
³⁸
Almeida O, Tamai S, Garrido R. Sleep in the Elderly- Sleep Complaints Among the Elderly: Results From a Survey in a Psychogeriatric Outpatient Clinic in Brazil. Int Psychogeriatr 1999; 11:47-56.
³⁹
Lasagna, L. Over-the-counter hypnotics and chronic insomnia in the elderly. J Clin Psychopharmacol 1995;15:383-386.
⁴⁰
Hoch CC, Reynolds CF, Monk TH, Buysse DJ, Yeager AL, Houck PR, Kupfer DJ. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep 1990;13:502-511.
⁴¹
Findley LJ, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Surratt PM. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest 1986;90:686-690.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
29 Oct 2008
Accepted
10 Nov 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Mitchell AJ. The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. Int J Geriatr Psychiatry 2008; 23:1191-1202.

[2] ²
Jungwirth S, Fischer P, Weissgram S, Kirchmeyr W, Bauer P, Tragl KH. Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. J Am Geriatr Soc 2004;52:263-268.

[3] ³
Bassett SS, Folstein MF. Memory complaint, memory performance, and psychiatric diagnosis: a community study. J Geriatr Psychiatry Neurol 1993;6:105-111.

[4] ⁴
Abdulrab K, Heun R. Subjective Memory Impairment. A review of its definitions indicates the need for a comprehensive set of standardised and validated criteria. Eur Psychiatry 2008;23:321-330.

[5] ⁵
Minett TS, Da Silva RV, Ortiz KZ, Bertolucci PH. Subjective memory complaints in an elderly sample: a cross-sectional study. Int J Geriatr Psychiatry 2008;23:49-54.

[6] ⁶
Dartigues JF, Fabrigoule C, Letenneur L, Amieva H, Thiessard F, Orgogozo JM . Epidemiology of memory disorders. Therapie 1997;52:503-506.

[7] ⁷
Coley N, Ousset PJ, Andrieu S, Matheix Fortunet H, Vellas B. Memory complaints to the general practitioner: data from the GuidAge study. J Nutr Health Aging 2008;12:66S-72S.

[8] ⁸
Clarfield AM. Reversible dementia--the implications of a fall in prevalence. Age Ageing 2005;34:544-545.

[9] ⁹
Hejl A, Høgh P, Waldemar G. Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neurol Neurosurg Psychiatry 2002;73:390-394.

[10] ¹⁰
Brucki S, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do Mini Exame do estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[11] ¹¹
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychosocial function. JAMA 1963;185:94-99.

[12] ¹²
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

[13] ¹³
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. Washington: American Psychiatric Association; 1994.

[14] ¹⁴
McKhannG, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[15] ¹⁵
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.

[16] ¹⁶
Morris JC. Mild Cognitive Impairment Is Early-Stage Alzheimer Disease - Time to Revise Diagnostic Criteria. Arch Neurol 2006;63:15-16.

[17] ¹⁷
Ganguli M, Dodge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type - An epidemiologic study. Neurology 2004;63:115-121.

[18] ¹⁸
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[19] ¹⁹
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256:240-246.

[20] ²⁰
Portet F, Ousset P J, Visser P J, et al. (EADC) European Consortium on Alzheimer's disease procedure. Report of the MCI working group of the critical review of the concept and new diagnostic Mild Cognitive Impairment in medical practice. J Neurol Neurosurg Psychiatry 2006;77:714-718.

[21] ²¹
Reisberg B, Prichep L, Mosconic L, et al. The pre-mild cognitive impairment, subjective cognitive impairment stage of Alzheimer's disease. Alz Dem 2008;4:S98-S108.

[22] ²²
Barry PP, Moskowitz MA. The diagnosis of reversible dementias in the elderly: a critical review. Arch Intern Med 1988;148: 1914-1918.

[23] ²³
Weytingh MD, Bossuyt PMM, van Crevel H. Reversible dementia: more than 10% or less than 1%? J Neurol 1995;242: 466-471.

[24] ²⁴
Clarfield AM.The decreasing prevalence of reversible dementias: an updated meta-analysis. Arch Intern Med 2003;163: 2219-2229.

[25] ²⁵
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of Potentially Reversible Dementias in a Dementia Outpatient Clinic of a tertiary University-affiliated Hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.

[26] ²⁶
Burke D, Sengoz A, Schwartz R. Potentially reversible cognitive impairment in patients presenting to a memory disorders clinic. J Clin Neurosci 2000;7:120-123.

[27] ²⁷
Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K. Depressive Symptoms, Vascular Disease, and Mild Cognitive Impairment. Findings From the Cardiovascular Health Study. Arch Gen Psychiatry 2006;63:273-280.

[28] ²⁸
Hudon C, Belleville S, Gauthier S. The association between depressive and cognitive symptoms in amnestic mild cognitive impairment. Int Psychogeriatr 2008;20: 710-723.

[29] ²⁹
Ellison JM, Harper DG, Berlow Y, Zeranski L. Beyond the "C" in MCI: Noncognitive Symptoms in Amnestic and Non-amnestic Mild Cognitive Impairment. CNS Spectr 2008; 13:66-72.

[30] ³⁰
Lin MY, Gutierrez PR,. Stone KL, et al. Vision Impairment and Combined Vision and Hearing Impairment Predict Cognitive and Functional Decline in Older Women. J Am Geriatr Soc 2004;52:1996-2002.

[31] ³¹
Lopes LC, Magaldi RM, Gândara MER, Reis ACB, Jacob-Filho W. Prevalence of Hearing Impairment in Patients with Mild Cognitive Impairment. Dement Neuropsychol 2007;3:253-259.

[32] ³²
Andrès E, Loukili N H, Noel E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004;171:251-259.

[33] ³³
Lindenbaum J, Rosenberg IH, Wilson PWF, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2-11.

[34] ³⁴
Hin H, Clarke R, Sherliker P, et al. Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. Age Ageing 2006;35:416-422.

[35] ³⁵
Manciet G, Dartigues JF, Decamps A, et al. The PAQUID Survey and Correlates of Subclinical Hypothyroidism in Elderly Community Residents in the South West of France. Age Ageing 1995;24:235-241.

[36] ³⁶
Knopman AU, Petersen RC, Cha RH, Edland SD, Rocca WA. Incidence and causes of nondegenerative nonvascular dementia: a population-based study. Arch Neurol 2006;63:218-221.

[37] ³⁷
Moore AR, O'Keeffe ST. Drug-induced cognitive impairment in the elderly. Drugs Aging 1999;15: 5-28.

[38] ³⁸
Almeida O, Tamai S, Garrido R. Sleep in the Elderly- Sleep Complaints Among the Elderly: Results From a Survey in a Psychogeriatric Outpatient Clinic in Brazil. Int Psychogeriatr 1999; 11:47-56.

[39] ³⁹
Lasagna, L. Over-the-counter hypnotics and chronic insomnia in the elderly. J Clin Psychopharmacol 1995;15:383-386.

[40] ⁴⁰
Hoch CC, Reynolds CF, Monk TH, Buysse DJ, Yeager AL, Houck PR, Kupfer DJ. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep 1990;13:502-511.

[41] ⁴¹
Findley LJ, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Surratt PM. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest 1986;90:686-690.

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