Determining the cause of memory loss in the elderly. From in-office screening to neuropsychological referral.

Improved understanding of neurobehavior in normal aging, Alzheimer's disease, and late-life depression makes early detection of neurodegenerative conditions possible. Primary care physicians can screen patients' mental status and mood states with simple in-office tests. When screening results or the clinical picture is ambiguous or complex, neuropsychological evaluation is useful in making an early, reliable differentiation between dementia and normal aging. Early identification of neurologic problems provides an opportunity to enhance quality of life and long-term care. Medical interventions, such as a trial of donepezil hydrochloride (Aricept) or other memory-enhancing medications as they become available, can be started when results are likely to be optimal. Common coexisting problems (e.g., depression, falls) can be sought and managed. Additional important medical decisions (e.g., elective surgeries) may be considered differently when dementia is diagnosed early.