Forgetfulness: Identifying Its Etiology and Character
History taking is a useful strategy in identifying the possible etiology and character of forgetfulness for an appropriate diagnosis. The clinical practitioner must collect data on the other symptoms accompanying forgetfulness (Townsend & Morgan, 2018). These include having trouble remembering the ways to familiar places such as home or work, misplacing things, difficulty grasping messages, and having repetitive questions (Falk et al., 2018). It is also key to inquire about the overreliance on keeping lists for memory and difficulties in following the plots of movies or stories by the patient, indicating anterograde memory challenges. These questions show the cognitive impairments of the client accompanying necessary for appropriate diagnosis.
Furthermore, it is significant to take a history of other behavioral and speech problems presenting with forgetfulness. Assess for any challenges with forgetting simple words or substituting words with other unusual words. Examine the patient for increased reliance on giving written instructions, reading difficulty, and inability to recognize familiar faces. Information on behavioral and personality changes such as being suspicious of others, decreased level of attention, rapid mood swings for no concrete reason, and loss of interest in previously pleasurable activities (Townsend & Morgan, 2018). Forgetfulness may also present with other behavioral and speech disturbances.
A comprehensive history requires taking information on the characteristics of the presenting symptoms. It is pertinent to inquire about the time of onset of the symptoms, impacts on familial relationships, effects on work, and the signs on patient safety. Additionally, the nurse should take the past medical and family history of the patient. The history of other diseases suffered in the past provides a clue on the possible causes of forgetfulness. A history of the medication use by the patient is also crucial. An in-depth account promotes the successful management of the condition.
Physical examination comprising neurological are useful indicators of the probable diagnosis of forgetfulness. Firstly, it is crucial to observe the gait of the client. Check for signs of decreased arm swings, imbalanced posture, and a short stride, which may indicate Parkinson’s disease or falls secondary to the disease (Deak et al., 2016). Second, assess the patient for signs of involuntary muscle movements at rest, including dystonia, fasciculation, myoclonus, or tremors, which indicate muscular problems. Third, it is imperative to determine the presence or absence of primitive reflexes such as asymmetrical tonic neck reflexes, grasp reflexes, and suck reflexes which are frontal release signs. These signs show the origin of brain injury causative of memory loss (Kern et al., 2016). Fourth, the nurse should assess the visual acuity, pupillary reflexes, visual fields, and eye movements of the patient to determine whether the vision is affected.
Several laboratory tests help provide objective findings to identify the source of forgetfulness. The common investigations include thyroid function tests to determine the level of thyroid hormones. Research show that high thyroid hormone levels are associated with cognitive difficulties and dementia (DeTure & Dickson, 2019). Moreover, it is necessary to assess serum calcium levels as vascular events, including ischemic cell death, are linked to high calcium levels in the brain (Kern et al., 2016). It is also significant to identify the blood levels of vitamin B12, and folate acid as deficiencies in these elements is related to forgetfulness. Additional tests to determine the root of the client’s forgetfulness include venereal disease research laboratory tests to rule out neurosyphilis, which has significant effects on the neurological functioning of the patients. Finally, imaging tests such as magnetic resonance imaging and computed tomography testing are crucial diagnostic tests for forgetfulness. They indicate the presence of intracranial bleeding, stroke, or parts of the brain injury which may be causative of forgetfulness in the patient (Townsend & Morgan, 2018). These tests enable the healthcare personnel to identify the probable reversible or irreversible causes of the patient presenting symptoms.
Numerous conditions present with progressive forgetfulness similar to the client. Firstly, the patient could have dementia as this is an impairment in an individual’s cognitive capacities, which results in significant behavioral and mental changes. These impairments impair the quality of life of the patient due to increased forgetfulness (Falk et al., 2018). Secondly, Alzheimer’s disease is a progressive deterioration of neuronal functioning due to the reduced size of the brain. It is characterized by significant disruptions in the behavioral and social skills of the patient. The third probable diagnosis of the client is delirium, which is an acute confusion state in the patient. It is a sudden change in the brain and emotional actions of the body due to a chronic illness, alcohol consumption, infections, or medication side effects. Fourth, depression is another possible cause of forgetfulness as it results in prolonged low mood and memory changes (Deak et al., 2016). Depression also results in reduced attention spans and mood variability in the patient.
Intensive diagnostic tests are required to rule out other minor causes of forgetfulness. Fifth, according to Yoon, Ooi & How (2018), the patient could be suffering from minor neurocognitive disorder (MCI). This refers to minor memory impairments in patients who still retain their functioning ability in most of their daily activities (Falk et al., 2018). Finally, Parkinson’s disease, which presents with progressive movement and cognitive difficulties, is another possible cause of forgetfulness. Therefore, a comprehensive history, physical examination, and diagnostic findings should be conducted by the nurse to identify the ideal diagnosis of the condition.
References
Deak, F., Kapoor, N., Prodan, C., & Hershey, L. A. (2016). Memory loss: Five new things. Neurology Clinical Practice, 6(6), 523–529. Web.
DeTure, M. A., & Dickson, D. W. (2019). The neuropathological diagnosis of Alzheimer’s disease. Molecular Neurodegeneration, 14(1), 1-18. Web.
Falk, N., Cole, A., & Meredith, T. J. (2018). Evaluation of suspected dementia. American Family Physician, 97(6), 398-405. Web.
Kern, J., Kern, S., Blennow, K., Zetterberg, H., Waern, M., Guo, X., Börjesson-Hanson, A., Skoog, I., & Östling, S. (2016). Calcium supplementation and risk of dementia in women with cerebrovascular disease. Neurology, 87(16), 1674–1680. Web.
Townsend, M., & Morgan, K. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F. A. Davis.
Yoon, P. S., Ooi, C. H., & How, C. H. (2018). Approach to the forgetful patient. Singapore Medical Journal, 59(3), 121–125. Web.