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'Am I losing my marbles Doc?'

By Philip Morris - posted Thursday, 6 January 2011


Over the next few years this will be a question many doctors will hear from patients. And some of us will perhaps ask this of ourselves!

As the leading edge of the "baby boomer" generation moves through their 60's and 70's many of them will start to wonder if memory complaints are the start of more serious cognitive problems or dementia. It is crucial to distinguish sinister memory problems from benign complaints that just become more common with age.


Forgetting one's keys, reading glasses, or difficulty finding a word or two in a conversation are more common as we age but are not concerning as long as they are not occurring all the time.

On the other hand, frequently needing to be reminded of what one has already been told or getting lost in previously familiar situations are more worrying symptoms that can indicate serious memory problems.

It is clinically important to determine whether memory complaints reflect "normal" aging or are evidence of developing pathology. Memory and cognitive testing can assist this process.

Office (or "bedside") testing is commonly done with the Mini Mental State Exam (MMSE). While quick and easy to administer it is not detailed enough to provide a dependable evaluation of cognition and memory, especially in mildly affected patients. I find the Addenbrooke's Cognitive Examination Revised (ACE-R) a more useful test.

The ACE-R includes the MMSE but covers more cognitive domains in depth (attention/orientation, memory, verbal fluency, language, visuo-spatial, and perceptual abilities)

The test is easy to administer and takes no more than 20 to 25 minutes in most cases. A practice nurse can administer the test.


The ACE-R is scored out of 100. Scores in the mid 80's suggest serious cognitive impairment or dementia. Most healthy elderly individuals will score in the 90's.

The ACE-R can identify patterns of cognitive and memory impairment that are useful in differentiating Alzheimer's disease from fronto-temporal dementia variants, vascular cognitive impairment, and Lewy body dementia. Some experience with interpretation of the test is needed.

Occasionally more extensive cognitive testing is required and referral to a neuropsychologist should be considered. Computer-based cognitive testing programs can be helpful in some cases.

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About the Author

Dr Philip Morris is Executive Director of the Gold Coast Institute of Mental Health. He is Medical Director of Mirikai, a young adult drug and alcohol rehabilitation program on the Gold Coast and he has a private psychiatric practice, The Memory Clinic, on the Gold Coast and in Brisbane. Dr Morris is the President of the Gold Coast Medical Association.

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