When Dr. Sangeeta Varanasi started the area's only Memory Disorders Clinic, she wasn't sure what to expect.

What she found was an alarming number of people coping with the one-two punch of memory loss and depression.

"I've seen more cases of depression than I thought I would," she says.

Varanasi is an internal and geriatric medicine specialist with the Pinehurst Medical Clinic (PMC). She practices at the Neese Clinic at Belle Meade.

"Most of the depression we see with Alzheimer's and dementia presents in the early stages of the disease," she says. "That's when patients are most aware they're losing memory and the ability to do complicated tasks like balancing the checkbook, cleaning the house, cooking; that sort of thing."

Patients who are dealing with depression and dementia pose a unique challenge for treatment, according to Varanasi.

"We treat both conditions, but try not to start two medications at the same time," Varanasi says.

Instead, these patients require frequent followup visits and are given mini-mental tests to regulate their progress and the effectiveness of their medications, she says.

There are many causes for memory loss. Age is a factor.

Varanasi says the research shows an increase in depression in people 65 and older. Often, people in this age group are taking so many different medications, their thinking is clouded.

Also, strokes can lead to dementia and depression due to the resulting chemical imbalance in the brain.

Lifestyle choices also impact the health of the brain.

"There is real concern for the population growing up now where we're seeing obesity in children as early as 12 years old," she says. "When those people reach age 50 they're going to get dementia and perhaps depression. In other words, there is an increased chance they are aging prematurely."

Varanasi has a 58-year-old patient who has been overweight most of his life and has high blood pressure that has gone unchecked for years.

"He is experiencing vascular dementia much sooner than someone who is following a healthier regime," she says.

Sometimes it's just fate that intervenes.

A few years ago, Bob Ormond was the picture of health. He was an avid outdoorsman who had owned his own ski business, was a scratch golfer and was running a 21-acre farm with five horses just outside Pinehurst.

Now at 69, he and his wife of 24 years, Mary, are struggling day to day.

"Bob got cancer," his wife says. "Nearly three years ago, they did surgery to his brain. Then he had radiation and was placed on medication. The end result is cognitive impairment. The cancer didn't kill him, but the cure certainly had an effect on his memory."

Mary Ormond isn't sure which came first, the memory loss or the surgery. All she knows is their lives have been turned upside down.

"For someone like Bob, who's been extremely independent, a whiz with numbers, extremely well-respected in his industry and so physically active to become this dependent and confused is really awful," she says.

The Ormonds now have a full-time caretaker for Bob, while Mary continues to work as the director of behavioral services for FirstHealth.

"I'd heard about Dr. Varanasi and her credentials, and I knew I wanted her to get involved," Mary Ormond says. "She has been terrific coordinating his care and in helping me deal with the here and now. She's finally made me realize it's not important to keep asking why."

Varanasi says one thing that is complicating Bob Ormond's case is the drug Lupron. It is used to battle prostate cancer. It can lead to temporary memory loss in some patients, until it fully washes out of the system, which may take a year or more.

While no one knows for sure if the drug had an initial impact on Bob's memory, it's clear they are faced with managing a difficult situation, Varanasi says.

"Dr. Varanasi has been working with us to identify the possibility of conflicting medications and to come up with creative solutions to some of the causes of his depression," Mary Ormond says.

In most cases, when Varanasi is able to treat the depression, patients do so much better.

"They socialize more, they feel better and are more inclined to get involved with community and family activities," she says.

That increased activity has an emotional and physical effect.

"The more hobbies you have, the more parties and Thanksgiving dinners you organize and plan, the better for your brain," she says.

The trouble with people who suffer from depression, Varanasi says, is that they are more prone to dehydration, poor nutrition, lack of sleep and they won't always take their medications. All of these factors then adversely affect their memory. It can be a vicious circle.

Becoming an informed health-care consumer is the best way to learn about the causes and treatments associated with Alzheimer's disease, dementia and depression, she says.

The screening questions for dementia include:

-- Frequent forgetfulness that interferes with daily functioning.

-- Episodes of confusion with time and place.

-- Difficulty performing everyday tasks.

-- Trouble remembering or choosing the right word.

-- Impaired recognition of familiar places or objects.

-- Episodes of poor or uncharacteristic decision.

-- Impaired abstract thinking that interferes with complex tasks.

-- Agitated or inappropriate moods or behavior.

Alzheimer's can be inherited. Know that even over-the-counter medications and some herbal remedies can lead to memory loss, according to experts. The sooner memory loss is detected the sooner it can be slowed.

"By prescribing certain medications we can keep your memory stable," Varanasi says. "It's the same thing with depression. We can't restore memory that's lost, but the earlier we intervene the more brain function there is to preserve. Denial of a problem does not lead to good results."

Varanasi recommends screening if you have any concerns about yourself or a family member. No referral is needed.

For more information about Memory Loss and Depression, contact Varanasi at Pinehurst Medical Clinic's Neese Clinic at 246-4140.