By Karen D. Sullivan, Ph.D., ABPP
While dementia is more common as we get older, it is not a normal part of aging. Dementia can be caused by different underlying disease processes, such as Alzheimer’s disease, vascular disease including stroke and heavy alcohol use, to name a few, but can also be due to treatable conditions such as depression, anxiety, medication effect or infection. The early and accurate diagnosis of memory loss, including dementia, allows for:
• A better chance of benefiting from disease-specific medications that can slow symptoms
• Early intervention to reduce risks factors that contribute to further memory decline
• The ability to plan for the future and maximally benefit from care and support services
• Reducing uncertainty about a change in thinking or behavior
• Providing education, support and community-based resources to the patient and family
• Informing important decisions about driving, living independently and level of supervision
• Providing a baseline for ongoing monitoring of cognitive symptoms and changing care needs
A neuropsychological evaluation can play a major role in diagnosing dementia. Neuropsychologists, doctors of clinical psychology who specialize in how the brain works, make dementia diagnoses through detailed interviewing, a review of medical records and comprehensive and standardized paper-and-pencil testing. The goal of a neuropsychological evaluation is to determine if changes in thinking and memory are related to normal aging, a medical condition or dementia followed with making personalized treatment recommendations that promote the highest quality of life and independence.
There are typically three parts to a neuropsychological evaluation:
Interview: The first part of the evaluation typically takes one hour. It provides the neuropsychologist a chance to learn about the personal, social and medical context within which the individual’s or family’s concerns occur. During the interview, a neuropsychologist will review many aspects of a person’s background including onset and progression of symptoms, medical diagnoses, medications, personal history, mental health, sleep, etc. It is often valuable to have both the patient and family members participate in the interview.
Testing: The second part of the evaluation typically takes two to three hours. A person’s test performances are essential for a neuropsychologist to gain a clear understanding of how the person is doing in comparison to other people of the same age and educational background, as well as compared to their own baseline. The goal is to identify areas of cognitive strength and weakness by behavioral observation and objective assessment of all cognitive domains, such as attention, memory and language. In addition, personality and mood symptoms, including possible depression and anxiety, are often examined.
Feedback: The third part of the evaluation typically takes one hour. This report is reviewed in the feedback session in detail and in everyday language. The goal of a feedback session is two-fold. First, it is important for the person to understand, in detail, the results of the evaluation. Second, it’s important to discuss the personalized treatment recommendations your neuropsychologist has decided will help to support the highest quality of life possible. Recommendations range from medication suggestions, pending physician approval, strategies for managing medical conditions that are contributing to memory decline, counseling for patient and family, level of care and supervision needed, environmental modifications, strategies for behavior change and patient and caregiver resources, including geriatric care management and community. support groups.