1) Benign forgetfulness or normal aging – difficult to recall some types of information like names of persons
2) Mild Cognitive Impairment – MCI – this is more severe than memory loss of normal aging and subset of persons with MCI will show progressive deline in the memory and ultimately may develop AD.
3) Stress
4) Anxiety states
5) Somatic anxiety states
6) Somatic depression syndrome
7) Depression
8) Hypothyroidism –
9) Apathetic hyperthyroidism – hyperthyroidism presenting with features of hypothyroidism like fatigue, psychomotor retardation, depression, weight gain
10) Dementia – Impairment in memory when associated with deficits in at least 1 other area of higher cognitive functioning like judgment, abstract thinking, complex task performance, agnosia, apraxia, visuospatial awareness, personality change in the context of above deficits, early signs and symptoms – getting lost in conversations, word-finding difficulty (anomia), left-right disorientation, aphasia, inability to copy drawing, early memory loss, cognitive problems in multiple domains, difficulty in learning and retaining new information, difficulty in finding one’s way in familiar surroundings, getting lost in familiar surroundings, aimless wandering, personality change into passive, suspicious, aggressive, confirm the diagnosis by Mini-Mental State Exam, routine laboratory investigations to exclude reversible causes of dementia (FBS, TSH, Electrolytes, S. Calcium, S. Glucose, S. B12 Levels), MRI if following criteria present (age < 60 yrs, rapid onset and decline in cognitive deficits, recent head trauma, localized neurological signs an symptoms, gait disturbance, urinary incontinence early in the history),
11) Multi-infarct dementia – memory deficit, anomia, limb apraxia (abnormal skilled movements of hand), difficulty in the calculation, gait dysfunction, urinary incontinence, reflex or motor asymmetry, paralysis of executive functioning,
12) Parkinson’s disease – tremors, slowed movements, gait disorder, amnesia, cognitive problems, masked facies, soft voice, tiny handwriting, limb rigidity cogwheel type, loss of arm swing in walking,
13) Transient global amnesia – TGA – sudden onset amnesia, leading to confusion, and anxious perseveration, lasting few hours, full recovery without any residual neuro deficits, no recurrences, middle-aged patients, anti-platelet therapy if risk factors for stroke present,
14) Head injury and Postconcussive syndrome – headache, poor memory, mental dullness, depression after a head injury, lasting few days to few weeks, and resolving in most cases
15) Drugs – hypnotics, antihistamines, psychotropic drugs, pain medicine used after surgery
16) Alcohol and Illicit drugs use – heavy alcohol use causes B1 deficiency and consequent memory problems
17) Sleep deprivation – lack of quality sleep can cause memory failure whether it is from stress, primary insomnia or even sleep apnea.
18) ADHD in adults – sense of restlessness, diffulty in relaxing and settling down, dysphoria when inactive, lack of concentration on detail, need to re-read material several times, forgetting activities and appointments, losing things, losing the thread of conversations, thoughts are unfocused, ‘on the go’ all the time, rapid shifts in mood from depression, excitability, irritability, temper tantrums, above behaviors causing relationship problems, disorganization in life common, uncompleted tasks, lacks problem solving strategies, lacks time management strategies, impulsivity causes problems with teamwork, abrupt initiation and termination of relationships, tendency to make rapid and facile decisions without full analysis of the situation, these symptoms might not be seen at the clinic situations but full blown in day to day life situations and obvious to family members and the co-workers, symptoms start early in life by definition before the age 7 yrs, symptoms are persistent and so long standing that they may look more like traits than new onset medial symptoms, in the adult ADHD mood instability is so common ADHD may be misdiagnosed as other affective disorders like minor affective disorders, personality disorders, comorbid conditions of ADHD are antisocial personality disorder, alcohol misuse, substance dependence, dysthymia, cyclothymia, anxiety disorders, general and specific learning difficulties, Utah criteria for adult ADHD are childhood ADHD AND hyperactivity and poor concentration with any 2 of the following – labile affect (that is euphoria, depression, anxiety, anger episodes, short lasting, usually intense emotions, usually patient says being out of control of emotions when in a affective swing), temper tantrums, inability to complete tasks and disorganization, stress intolerance, impulsivity, Tx – Methyphenidate (start with 5-10 mg daily titrating to a maximum of 40-90 mg daily), Pemoline (start with 37.5 mg daily and titrate to 75 mg daily), Desipramine (start with 10-20 mg daily, titrate to 100-150 mg daily), Imipramine (start with 10-20 mg daily, titrate to 100-150 mg daily), Nortriptyline (start with 10-20 mg daily, titrate to 100-150 mg daily), Bupropion (start with 37.5, titrate to 300-450 mg )
19) Recoverable Cognitive Decline – RCD – acute illness, hospitalization for the acute illness, reduction of admission MMSE score by 3 points at least by discharge, cognitive decline is unexplained by delirium (CAM criteria – acute onset and fluctuating course, inattention, disorganized thinking, altered level of consciousness) nor dementia (presence of cognitive symptoms at least for 6 months), higher educational level, higher preadmission functional impairment, higher illness severity, risk factors for RCD,