A DEMENTIA PRIMER: WHAT TO LOOK FOR, WHO TO ASK AND WHAT TO DO

1. A DEMENTIA PRIMER: WHAT TO LOOK FOR, WHO TO ASK AND WHAT TO DO A.J. ZOLTEN, PH.D. Director of Neuropsychology and Psychology Services 8 Shackleford Plaza, #201 Little Rock, AR, 72211 Office: 501-219-8999 Fax: 501-219-8544

2. Memory functioning is stable during Early adulthood. Modest declines in memory after age 40 are not uncommon. Changes occur in mental flexibility with age. Complex learning functions are the first to go. Memory decline becomes more dramatic in later years Memory problems evolve into dementia MEMORY DECLINE HAS A PREDICTABLE COURSE

3. DEFINING DEMENTIA AND ALZHEIMER’S DISEASE Dementia is like Heart Disease • There are different kinds of dementia just like there are different kinds of heart problems. • Alzheimer’s disease is a type of dementia, just like coronary vascular disease. • Alzheimer’s disease is the most common cause of dementia • Vascular dementia is the second most common cause of dementia

4. MEMORY DISTURBANCE Recall of previously learned information Inability to access long-term memory on demand Inability to learn new information Excessive and/or rapid decay of new information OTHER PROBLEM AREAS Motor coordination Language Insight Decision making and problem solving skills Changes in Personality Functioning MOST COMMON SYMPTOMS OF DEMENTIA

5. AGING OR ALZHEIMER’S? ACTIVITY AGING ALZHEIMER’S Forgets Parts of Whole experience experience Remembers later Often Rarely Follows written or spoken directions Usually able Gradually unable Can care for self Usually able Gradually unable

6. FUNCTIONAL ASPECTS OF DEMENTIA Dementia Means that the patient can no longer function independently • Finances • Home upkeep • Community Activities • Activities for Daily Living • Medication Management • Driving/travel/transportation

7. DIAGNOSIS OF DEMENTIA: WHO AND HOW • Primary Care Physician Usually the front line of elder care Usually a brief examination of cognitive functions (MMSE) Usually refers to a specialist • First Line Specialists-Neurologists/Psychiatrists Inventory of symptoms is more thorough Cognitive examination should be standard (still MMSE) Refer to Dementia specialist • Dementia Specialists-Gerontologist Rule out alternative diagnoses Integrate medical history Integrate psychosocial history Get appropriate neurodiagnostic imaging Get Neuropsychological test data • Dementia Specialists-Neuropsychologist Thorough evaluation of memory and cognition Integrate psychosocial history

8. PSYCHOLOGICAL ISSUES Premorbid intelligence Educational attainment Work History Past/current level of independence Psychological adjustment Treatment history Current mental health status SOCIAL ISSUES Family history Marital issues Economic status Psychosocial support Community integration KEY ISSUES IN PSYCHOSOCIAL ASSESSMENT FOR DEMENTIA

9. MEMORY FUNCTIONING IS AFFECTED BY ENVIRONMENTAL FACTORS • Stress from job, family, social life, obligations, changes etc. • Depression, anxiety, other mood disturbances • Inattention due to multiple demands in the environment

10. ESSENTIAL FEATURES OF NEUROPSYCHOLOGICAL EVALUATIONS General Cognitive Abilities-WAIS-4 • Vocabulary, Abstraction, Problem Solving, Attention, Fund of Knowledge, Nonverbal Reasoning Memory-WMS-4 • Historical, Auditory, Visual, Working, Orientation • Person, Place, Time, Reason for Visit Language • Naming skills, Fluency Executive Skills Motor Skills

11. COMMON REASONS FOR MISDIAGNOSIS • Polypharmacy/medication side effects • Depression or other psychiatric diagnosis • Misdiagnosis of psychiatric condition with poor treatment choice • Lack of appropriate medical diagnosis (condition not recognized) • Lack of appropriate medical treatment

12. BENEFITS OF ACCURATE DIAGNOSIS AND TREATMENT • Early intervention with the appropriate treatment modalities • Extending independence and quality of life • Allowing research to catch up with progression • Activating psychosocial support • Giving time to plan for the future