“Lately, I keep forgetting names and can’t recall where I put my wallet… I thought it was just aging, but now I’m starting to worry.”
✅ What You’ll Learn in This Article (3 Key Takeaways)
- A structured approach to history taking and physical examination for memory loss
- How to identify signs of potentially treatable dementia
- Important differentials and red flags often overlooked in primary care
🧓 Case Introduction
“I’ve been forgetting names more often, and I can’t seem to remember where I put my wallet. I thought it was just part of getting older… but it’s starting to worry me.”
🧭 First Impressions: How Should We Think About This?
As a primary care physician or a resident handling outpatient visits,
you’ll often hear complaints like,
“I’ve become really forgetful lately…”
Especially when a patient with a history of dementia revisits saying,
“My memory’s getting worse again,”
you might be told by a senior doctor:
“Can you take care of this one?” or “Just talk to them for now.”
But hidden among these routine consultations may be patients
we absolutely cannot afford to miss.
We tend to dismiss complaints like “forgetfulness” as just part of aging. However, lurking beneath could be a treatable form of dementia.
Let’s break down this presentation by FPH methods.
🧠 Fact / Problem / Hypothesis
- Fact: The patient reports increasing forgetfulness, such as names and object placement.
- Problem: Chronic, progressive memory loss in an elderly patient. Not associated with acute onset or clear triggers.
- Hypothesis (using VITAMIN CDE):
Vascular, Infection, Trauma, Alcohol/Wernicke, Metabolic (B12, TSH), Iatrogenic, Neurodegenerative, Depression/Delirium, Epilepsy
🪜 Step 1: History Taking
We begin with OPQRST + PAM HITS FOSS.
Key History Questions:
- “When did the forgetfulness start? Was it sudden or gradual?”
- “Is it getting worse over time, or does it come and go?”
- “Do you forget how to cook or get lost in familiar places?”
- “How have you been feeling emotionally? Any sadness or low energy?”
- “Do you drink alcohol? If so, how much and how often?”
- “Have there been any changes to your prescriptions recently?”
🧠 Always ask about ADLs (bathing, toileting, shopping, cooking, etc.), and consult family for collateral information.
🧍♂️ Step 2: Physical Examination
- Full neurological exam (gait, tremors, rigidity, focal deficits)
- Mental status screening (e.g., MMSE, MoCA)
- Mini-Mental Status Sample Questions:
- “What is your name and age?”
- “Where are you right now?”
- “Repeat after me: chair, bed, pen.”
- “Spell ‘world’ backwards.”
🔬 Step 3: Diagnostic Tests
Labs:
- CBC, B12, TSH, glucose, liver/renal panel
Imaging:
- Brain CT or MRI: trauma, hydrocephalus, atrophy
Consider:
- Syphilis or HIV testing
- EEG if seizures suspected
Red flags: sudden onset, focal deficits, altered consciousness, rapid decline
Okay,
Now we’ve went through how to approach a vague but critical complaiant: Memory loss.
Apply this approach for the initial case.
🌀 Revisiting the Case
The patient has progressive forgetfulness affecting daily life, confirmed by family.
MMSE score: 24/30 (recall and attention deficits)
Normal labs (B12, TSH), brain MRI shows hippocampal atrophy.
What comes in your mind?
How likely does this patient have treatable dementia?
In this case,
I concluded:
→ Likely early Alzheimer’s. But treatable causes have been ruled out.
Start planning for safety, education, and cognitive support.
Eventually this case was simple, ordinally one with no complications or red flags
But with all the evidences to rule out treatable dementia,
I could explain what was going on to the patient and how to manage it
with confident.
🧠 Tips for Practice
- Always talk to both patient and caregivers
- Depression can mimic dementia—screen thoroughly
- Rule out treatable causes before concluding it’s neurodegenerative
💡 Clinical Pearls
“Not all dementia is irreversible.”
This phrase stuck with me as a student—and still guides me in every memory consultation.
🗣️ Useful Medical Expressions
- “Do you often forget names or appointments?”
- “Has this forgetfulness been affecting your daily life?”
- “Would you say it’s getting worse over time?”
💬 Layman’s Terms & Idioms
- “I’ve been feeling foggy lately.”
- “My mind just goes blank sometimes.”
- “It’s like I walk into a room and forget why I went in.”
📖 Medical English Glossary
- MMSE: Mini-Mental State Examination
- ADL: Activities of Daily Living
- NPH: Normal Pressure Hydrocephalus
- Treatable dementia: Dementia due to reversible causes (e.g., depression, B12 deficiency)
📘 Summary
It’s easy to brush off memory complaints as “just aging.” But sometimes, treatable conditions are hiding in plain sight.
The key is to listen carefully and notice what’s different.
Just that little extra attention can make a big difference in a patient’s future.
🔗 Related Articles
- Symptom-Based Approach: Palpitations
- Symptom-Based Approach: Fatigue
- Symptom-Based Approach: Depression
📚 References
- UpToDate: Approach to the patient with memory complaints
- Harrison’s Principles of Internal Medicine, 20th ed.
- DSM-5: Neurocognitive Disorders
- Japanese Society of Neurology: Dementia Clinical Guidelines 2021