Sarah Wakefield

Memory difficulties are not always a sign of incipient dementia: a review of the possible causes of loss of memory efficiency

INTRODUCTION OR BACKGROUND Memory problems are a very common reason for presenting to primary care. There is a need for better treatments for dementia. Increased government and media interest may result in greater number seeking help for memory problems, which may not reduce the dementia gap but rather increase numbers seen who do not have dementia. This review highlights the issues around the diagnostic criteria and terminology used for people with memory complaints. SOURCES OF DATA A comprehensive literature search using PubMed using keywords for articles on subjective memory decline (SMD)/impairment/complaints, subjective cognitive decline (SCD), mild cognitive impairment (MCI) and functional memory disorder (FMD). AREAS OF AGREEMENT There is a need for early accurate detection of dementia syndromes so that trials of new treatments can begin earlier on the disease process. AREAS OF CONTROVERSY Diagnostic criteria and terminology used for disorders of memory including SCD, MCI and FMD. GROWING POINTS This article reviews SCD and whether this can be used to predict Alzheimers disease. The review also discusses the terminology used for non-progressive memory problems and the long-term outcomes for this patient group. AREAS TIMELY FOR DEVELOPING RESEARCH The accurate distinction of premorbid dementia syndromes from benign non-progressive memory problems. Studies of treatment options for people with benign non-progressive memory problems and longer-term follow-up to determine which patients develop chronic problems.

Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders

Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders.

Differentiating Normal from Pathological Brain Ageing Using Standard Neuropsychological Tests

To diagnose Alzheimers disease (AD) early, tests sensitive to neuropathology and insensitive to normal ageing are of greatest benefit. We used several neuropsychological tests to identify those best suited to distinguishing Mild Cognitive Impairment (MCI) and early AD from normal ageing. Impairments in long-term memory were found in older adults and these were even greater in MCI and AD. Older adults outperformed young controls on category fluency and produced later acquired and less familiar words. Older adults also outperformed both patient groups on this task producing more words which were significantly later acquired, less familiar and less typical. Decline in long-term memory appears nonspecific and in the early stage of AD cannot help the differentiation between normal and pathological brain ageing. Normal ageing has no negative effects on verbal fluency, and impairment on this task signals not only established AD, but also its prodromal MCI stage.

CONVERSATION ANALYSIS IN THE MEMORY CLINIC

Introduction Conversation Analysis (CA) can help with the differential diagnosis of seizure disorders. We investigated if CA could be used in the memory clinic to distinguish neurodegenerative (NDD) from functional memory disorders (FMD). Methods We recruited consecutive, patients newly referred to the Neurology-led memory Clinic. Consultations were video & audio recorded. All participants underwent detailed Neuropsychology testing and MRI. Results 111 patients of 178 approached were recruited (20 ND, 24 FMD, 87 other). We identified profiles of 14 interactional features that can distinguish NDD from FMD consultations based on encounters with 15 patients with NDD and 15 with FMD. Features of NDD included an inability to answer compound questions fully, inability to give detailed examples of memory failures, shorter length of turn and reduced complexity of replies. Prospective analysis of an additional 10 encounters proved that Conversation Analysts could use these features to predict the diagnoses of FMD and ND with high sensitivity and specificity. Conclusions Simple differences in the communication behaviour of patients can help to distinguish between ND and FMD, suggesting that a targeted observation of interactional features could improve screening for ND in primary or secondary or care settings.

CONVERSATION ANALYSIS IN THE MEMORY CLINIC TO DISTINGUISH DEMENTIA FROM FUNCTIONAL MEMORY DISORDER

CLINIC TO DISTINGUISH DEMENTIA FROM FUNCTIONAL MEMORY DISORDER Daniel J. Blackburn, Chris Elsey, Sarah Wakefield, Kirsty Harkness, Annalena Venneri, Paul Drew, Markus Reuber, University of Sheffield, Sheffield, United Kingdom; University of Loughborough, Loughborough, United Kingdom; 3 Sheffield Teaching Hospitals, Sheffield, United Kingdom; IRCCS San Camillo Hospital Foundation, Venice, Italy. Contact e-mail: d. blackburn@sheffield.ac.uk

COMPARING THE NEUROPSYCHOLOGICAL PROFILES OF PATIENTS WITH MEMORY DISORDERS OF DIFFERENT AETIOLOGY

with a mean of 12.6 years of education (8-17). The mean number of professional fights was 45.2 and years of professional fighting, 14.3. Impairments on cognitive tests were frequent, with 43% failing a psychomotor speed test, 57% failing a processing speed test and 28.6% failing a memory test. The memory test was failed by a similar proportion of active fighters, while less active fighters failed the tests involving speed. . When corrected for age and other relevant variables, thalamic volume did not differ between active and retired fighters, but a greater fight exposure was associated with smaller volumes (p1⁄4.0.031). Conclusions: Cognitive dysfunction is common in retired fighters, and may be associated with specific changes in the brain. Timed tasks are particularly vulnerable, whereas impairment in memory is seen similarly in younger, active fighters. Analysis of larger groups of fighters will further elucidate this relationship.

Utilising detailed neuropsychological assessment in the differential diagnosis of mild cognitive impairment, Alzheimer's disease, frontotemporal dementia and vascular dementia

that, according to the Plymouth Dementia Screening Checklist, 2 individuals punctuated above the cut-off point -3-(out of 9) with relevant compromise in memory and behavior. One of these individuals presented a mild cognitive decline, being in stage 3 of GDS. At follow-up, there was an increase in the number of individuals who registered changes both in PDSC and in GDS. Seven individuals had scores above the cut-off in PDSC, being memory the most compromised skill. Of these DS adults, 2 were identified as having very mild cognitive decline (stage 2 of GDS), 1 as having mild cognitive deterioration (stage 3), and 3 as having moderate signs of deterioration (stage 4). A strong positive relation was found between the results of PDSC and GDS at follow-up (r 1⁄4 .91, p <.001). Conclusions: The PDSC proved to bea good screening tool whenever the possibility of dementia was a concern in DS individuals. Memory deterioration was the most frequently observed change. These complaints were more outstanding in the older individuals of the sample, confirmed by GDS. These individuals seem to develop cognitive decline earlier than the general population. Given the possibility of developing dementia in thosewho already have warning signs, a more extensive neuropsychological assessment is needed in order to confirm the diagnosis and implement adequate therapeutics. The value of PDSC and GDS in the initial diagnostic process of dementia in Down syndrome is recognized.

Neuropsychological predictors of conversion in mild cognitive impairment

Parkville, Australia; Mental Health Research Institute, Melbourne, Australia; Edith Cowan University, Perth, New York, Australia; CogState Ltd, Melbourne, Australia; University of Melbourne, Melbourne, VIC, Australia; Austin Hospital, Melbourne, Australia; National Ageing Research Institute Inc. (NARI), Melbourne, Australia; Austin Health, Melbourne, Australia; Austin Hospital, Heidelberg, VIC, Australia; St Georges Hospital, Kew, Australia; Mental Health Research Institute, Perth, Australia. Contact e-mail: c.restrepo@student.unimelb.edu.au

The changing face of the memory clinic in Sheffield, United Kingdom

Background:There are approximately 800,000 people in the UK diagnosed with dementia. In 2009, the National Dementia Strategy (NDS) sought to improve awareness and access to services for the early diagnosis and support of this patient group 3, with a key aim of a memory clinic in every town. Data published by the Alzheimer Society (www.alzheimers.org.uk) suggest that 63% of people with dementia in Sheffield have been identified and diagnosed. This is one of the highest diagnosis rates in the UK. The memory clinics in Sheffield are divided into a clinic for patients older than 65 and run by old age psychiatry that sees >800 new referrals and the <65 or working age memory clinic run by neurologists, which sees >150 new referrals per year. In this study we reviewed whether raised awareness of dementia has altered the pattern of referrals to a memory clinic.Methods: Service review for all new referrals seen in the <65 memory clinic in Sheffield from 2004, 2006 (both 6 months) & 2012. Results: In 2004 and 2006 showed that approximately 1/3 of patients, whom had been given a diagnosis did not have dementia but had non-progressive memory complaints (either in the context of a mood disorder or Functional Memory disorder defined as subjective memory complaints of duration longer than 6 months, without organic or major psychiatric cause, normal brain imaging and neuropsychological tests of memory above 1.5 SD) but by 2012 this had increased to just over 50%. Conclusions: An early analysis confirms factors previously described in FMD such as work stress (in particular change in work pattern), chronic pain (back pain and migraine) and pre-morbid high achievement with a catastrophising misinterpretation of memory failures as the main triggers of non progressive memory disorders. Raised awareness of the early symptoms of dementia may be increasing the number of inappropriate referrals to memory services and suggests that more should be done to inform practitioners in primary care to achieve better triage. The current economic climate and impact on employment and financial hardship may be contributing to FMD and is also worthy of exploration.