Recent-memory problems can occur and are easily mistaken for early dementia. For all patients, a careful drug history, including nonprescription medications, must be part of any evaluation for increasing cognitive problems.
Cognitive difficulties can also result from exposure to toxins in the environment.
When multiple members of the same family, particularly younger patients, have problems simultaneously, possible exposure to household or automotive carbon dioxide or carbon monoxide or similar toxic inhalants should be considered. Malfunctioning home heaters are common, especially in rural settings, and low-level fumes are a significant problem. Elderly people may suffer insidious cognitive difficulties, whereas younger members of the family may complain of headaches, nausea, and other symptoms as being more prominent. The onset of symptoms can be gradual and go virtually unnoticed, occurring more frequently in colder weather. A useful and inexpensive diagnostic adjunct can be the purchase of carbon monoxide detectors for the home.