Alzheimer’s Disease, Memory Loss, Dementia, and Neuropsychological Evaluations

Memory Loss or Cognitive Decline–Worried about Alzheimer’s Disease?

The memory circuits of the brain for immediate memory are very specific. They lie deep in the brain and involve the hippocampus. Alzheimer’s Disease, as well as Frontotemporal Lobar Degeneration and other dementias causing memory loss, like stroke and inflammation resulting from the remote effects of cancer elsewhere in the body, involve these deep areas of the brain. But these circuits must have the proper “voltage,” or attention input, to function properly. Only when these structures are “awake” and we’re alert (sleep problems play a critical role in this), and the nerve cells in these structures are functioning well, can they help the other areas of the brain lay down more lasting memories. They do this by changing the way networks of nerve cells in the brain fire and signal each other. This is how we remember names, events, faces, and other things we all need to remember.

When an abnormal process involves the laying down abnormal amounts of phosphorylated tau protein to form neurofibrillary tangles in nerve cells, these abnormal structures can disturb the functioning of these nerve cells, wherever they are in the brain. Depending on where they occur, and other abnormal structures they are sometimes associated with, memory loss can be a part of Alzheimer’s disease, Frontotemporal Lobar degeneration, Multisystem Atrophy, Lewy Body Disease, and other diseases we neurologists broadly classify as dementias. Where in the brain these abnormal structures have destroyed nerve cells and led to “atrophy,” or shrinkage of the brain, will determine what abnormal behaviors are associated with memory loss.

There are many reversible causes of memory loss or cognitive decline, and it’s important to check for each one, even if a disease like Alzheimer’s Disease is present. Only in this way can a person maintain as much quality of life for as long as they can.

Sometimes, detailed neuropsychological testing has to be done to find defects in our thinking, or what we call cognitive function. Some of these tests are very specific to memory. Others involve personality testing and other functions of the brain. Imaging of the brain with MRI can show areas of degenerated nerve cells. PET scans can show areas of plaque accumulation in Alzheimer’s Disease. The circuitry of the brain can be tested to show if any abnormal electrical activity is occurring to disturb memory function. Blood work can be carried out to see whether any electrolyte abnormalities, vitamin deficiencies, or inflammation is occurring. Sometimes spinal fluid testing can be carried out to determine levels of degeneration.

Much is being learned about dementia through research. We at the RNI carry out clinical trials on dementia through our Research Center, including trials in Alzheimer’s Disease.

But at the RNI, our primary focus is on improving the quality of life for every single patient. To do this we have to be as sure as we can be about the correct diagnosis, and we need to make sure other factors, called comorbidities, are not making clinical symptoms worse.

If you have memory loss, don’t wait.

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The role of neuropsychological evaluation in diagnosis and quality of life

Neuropsychological evaluations not only test memory and other cognitive functions, they can suggest how a person can make real life decisions every day, and how much help they need in decision making, driving, and relating to others.

Neuropsychological evaluations involve three factors:

  • Testing must be completed in a supportive and positive environment
  • One-on-one feedback must be given, and results explained in understandable terms
  • A plan for intervention and coping with difficulties must be provided

All this may take a while. The testing part of the evaluation typically takes 3-4 hours to complete. A feedback session is then scheduled, where results are reviewed and suggestions for intervention offered with the patient and, if appropriate, the caregiver.

Why a neuropsychological evaluation might be useful for you or a loved one

  • find possible problems with brain functioning
  • help to identify other cognitive or mental health issues
  • define brain-related strengths and weaknesses
  • guide treatment for a person’s personal, educational and/or professional needs
  • document possible changes in a person’s functioning over time

What is a neuropsychological evaluation?

A neuropsychological evaluation typically involves assessment of a person’s brain functioning with a group of standardized tests. These functions (e.g. memory, learning) form the necessary building blocks for successful living in an individual’s daily life.

How long will a neuropsychological evaluation last?

Most testing sessions are pretty detailed and can last up to 3 – 4 hours, though sometimes it doesn’t take that long.

What tests are used?

Standardized tests are used to assess the following:

  • Attention/concentration
  • Memory/learning
  • Problem-solving
  • Visual-spatial
  • Language
  • Motor
  • Emotional functioning
  • Achievement skills

Scheduling is easy at the RNI. Even though it’s good to have a neurological exam to help identify problems ahead of time, neuropsychological testing with Dr. Winsby can be scheduled by any provider when that person think it’s appropriate. Questions about insurance coverage can be answered as well. To schedule a neuropsychological evaluation with Dr. Wimsby at either the Northland or Lenexa offices, please call 913-894-1500.