Is It Working: Memory

Monitoring Clinical Markers 

1. Cognitive Performance

  • Memory screens (MoCA, MMSE): Scores stable over 6 months (≤1-point change).

  • Episodic memory: Better retention of names, places, recent events.

  • Working memory: Fewer errors in short-term tasks (phone numbers, lists).

  • Marker: Plateau in memory lapses by 3–6 months.

2. Attention & Executive Function

  • Sustained attention: Less distractibility during tasks.

  • Problem-solving: Stable performance in daily planning or organization.

  • Marker: Trail Making or similar executive tasks steady.

3. Daily Living Abilities

  • Instrumental ADLs: Stable independence in finances, shopping, appointments.

  • Basic ADLs: No increase in assistance needed.

  • Marker: No new errors requiring outside help.

4. Neuropsychiatric & Behavioral

  • Mood stability: Less irritability tied to cognitive effort.

  • Apathy/anxiety: Reduced episodes of frustration from forgetfulness.

  • Marker: Lower stress reactivity tied to memory tasks.

5. Sleep & Circadian Rhythm

  • Sleep quality: Fewer mid-night awakenings; more restorative rest.

  • Daytime alertness: Reduced drowsiness; steadier focus.

  • Marker: Noticeable within 2–8 weeks.

6. Language & Communication

  • Word-finding: Stable or reduced frequency of retrieval pauses.

  • Conversation flow: Fewer interruptions from loss of thought.

  • Marker: Family/caregiver notices smoother exchanges.

7. Motor & Coordination

  • Handwriting/drawing: Stable legibility and planning.

  • Gait dual-tasking: Walks steadily even while recalling or talking.

  • Marker: No new hesitancy in movement during memory tasks.

8. Safety Markers

  • Navigation: No new disorientation in familiar environments.

  • Cooking/medications: Independent management with no new accidents.

  • Falls: No increase in fall rate linked to cognitive decline.

9. General Health

  • Nutrition & hydration: Stable appetite and daily rhythm.

  • Energy: Steadier stamina across the day.

  • Marker: No decline in overall vitality.

10. Optional Medical/Lab Biomarkers

  • B12, folate, thyroid, vitamin D: Optimized to prevent reversible impairment.

  • Inflammation: CRP/homocysteine stable or declining.

  • Neuroimaging (if used): Slower-than-typical hippocampal atrophy rates.

11. Caregiver Markers

  • Burden levels: Stable or reduced perceived strain.

  • Support hours: No increase in time required for supervision.

12. Long-Term Trajectory

  • Cognitive slope: Decline slowed compared to untreated baseline.

  • Function: ADLs preserved over 6–12 months.

  • Safety: No new major safety incidents.

  • Healthcare utilization: No rise in urgent visits due to cognitive decline.

Timeline of Expected Change

  • Weeks (2–8): Better sleep and attention, fewer mood swings around forgetfulness.

  • Months (3–6): Stabilization of daily memory lapses; no increase in functional errors.

  • Years (6–12+ months): Preservation of independence and slower decline in global cognition.