If you have concerns about your memory or thinking as you get older, you are not alone! One study found that up to 95% of older adults report some changes in their memory and thinking. This concern is often accompanied by fear that the perceived memory changes herald the onset of dementia. Your doctor may suggest a neuropsychological assessment, which can help determine whether these fears are founded.
What does a neuropsychological assessment involve?
Clinical neuropsychologists are trained to assess the relationship between brain function and thinking, memory, and behaviour. Assessment often begins by discussing the types of memory changes occurring, when they are noticed, and how long this has been going on for. Other possible contributing factors such as medical conditions, medications, and stressors are also explored. The neuropsychologist integrates this background information with results from administration of a number of standardised tests looking at memory, as well as other areas of thinking including attention, speed of thinking, language ability, visual skills, planning, and organisation. We can then compare your performance to what would be expected of someone of a similar age and background. This helps us determine if you are performing similarly to your peers, or are demonstrating some difficulties in memory or thinking.
How are the results used?
The overall pattern of your memory and thinking performance, in the context of your background information, enables the neuropsychologist to make clinical judgements regarding the likely contributing factors to your memory concerns. This includes determining whether the pattern of results is consistent with an underlying dementia or not. If there is an underlying dementia, often our assessment helps determine the most likely type of dementia (for example Alzheimer’s disease, vascular dementia, frontotemporal dementia, or dementia with Lewy bodies).
When there is uncertainty about decline, our first assessment with someone serves as a “baseline”, and we might ask you to come back around 6 – 18 months down the track. At this follow-up assessment, we can determine if the observed pattern is stable, improving, or getting worse. We can assess what other factors may have changed during that time, which can help determine reasons for any changes. For example, someone who had symptoms of depression during their baseline session may have received treatment in the meantime with a consequent lifting of mood, along with improved memory and thinking ability.
What about neuropsychological interventions?
Neuropsychological intervention can be useful for older adults wanting to inform themselves about keeping their brain healthy, people who are worried about their memory and thinking, or have mild cognitive difficulties, and for people with dementia (of any type), as well as their carers and family. One thing neuropsychologists can do is provide information on what to do to reduce the risk of developing dementia and keep cognition operating as efficiently as possible. Research suggests at least 35% of the risk of developing dementia is due to modifiable factors. Neuropsychologists can discuss these factors with you, and assist you to implement strategies to help reduce your risk factors.
We can also work with you to identify other factors impacting on your cognition, and brainstorm ways to effectively deal with these. Common co-morbid factors in older adults concerned about their memory include sleep issues, anxiety, reduced confidence, and a lack of routine. After dealing with some of these, we can teach specific evidence-based strategies for improving thinking and memory in daily life. These strategies are most effective if they focus on everyday issues that you have identified as your main goals, or things that you most want to work on. Often, a neuropsychological intervention works best over multiple sessions with “homework” tasks so you can try strategies in everyday life, and problem-solve with the neuropsychologist about what went well, and what may need further refinement. Interventions can be run on an individual basis, or in a group format, like the LaTCH memory management group program. Individual or group sessions for family members and carers can also be useful, covering topics such as increasing understanding of the underlying disease and their family member’s symptoms, providing strategies for managing symptoms the carer finds difficult, and self-care for the carer.
I am very pleased to offer neuropsychological assessment and intervention services for older adults at YCP. If you would like to enquire about an assessment or intervention, please contact us on 9429 0050. Referrals can be faxed to 03 8678 0645.
© Dr Kerryn Pike, 2018
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