About Memory Testing
Neuropsychological Evaluation:
For the past 25+ years we have offered neuropsychological evaluation of memory and other neurocognitive disorders associated with aging. We no longer use the term “dementia”; instead we talk about a Neurocognitive Disorder (NCD). NCD affects a person’s ability to function socially, manage at work/school, enjoy leisure activities, manage finances, shop and cook, etc. These functions are called Instrumental Activities of Daily Living or IADLs. More basic daily functions like grooming, dressing, eating, toileting and transferring from chair to standing are called basic ADLs.
Neurocognitive Disorders
Neurocognitive Disorders are divided into two categories: Mild and Major. Mild NCD is what used to be called Mild Cognitive Impairment, and many still use that term. Mild NCD involves cognitive changes that affect a person’s instrumental ADLs, but s/he can still manage all of their basic ADLs. The more advanced stage of impairment is called Major NCD and it affects not only IADLs, but also causes impairment in basic ADLs as well. Both Mild and Major NCD can be caused by many factors. An important fact is that while all people with Major NCD previously passed through Mild NCD, not all folks with Mild NCD go on to develop Major NCD. When we “catch” Mild NCD early we’ll discuss preventive strategies to reduce the risk of progression to more advanced cognitive impairment.
Testing compares a patient to their peers in their same age bracket to see if their difficulties are typical, or worse then expected at that age – if worse that can yield a diagnosis of Mild or Major NCD. These changes usually affect memory, word-finding ability, verbal fluency and reasoning/judgement skills which are all assessed in a Neuropsychological (NP) Evaluation. Based on medical history, review of ADLs and test scores we can infer likely causes of Mild and Major NCD; e.g., Alzheimer’s disease. If we don’t find evidence of NCD we look elsewhere for conditions (like anxiety and depression) that might be interfering with memory and functioning.
Why Use Neuropsychological Tests?
There is currently no blood test, X-ray, physical exam or brain scan that can reveal changes in a person’s cognitive status (thinking ability) – which is why we rely on NP testing. Medical exams are important to rule out issues like Lyme disease, hypothyroidism, etc. that could be treated and cured often before going forward with NP testing. This is called ruling out reversible causes of NCD. Your doctor may even order a brain CT or MRI scan to rule out things like brain tumor (which can be treated by surgery or radiation). However, brain scans cannot diagnose NCD, and the atrophy (shrinkage of the brain) that can show up on a brain scan is often normal in aging people. Finally, you may be referred to a neurologist or psychiatrist, who may refer you on to us with specific questions. Since we do different things this isn’t a duplication of services, but instead part of a more comprehensive workup.
Standardized tests are given in exactly the same way, every time, so as to reliably allow us to compare your scores to other people similar to you in age and education to look for NCD, or to rule it out. An important benefit to tests vs. interview is that tests yield numerical scores which can then be used to see improvement/stability vs. decline over repeat testings at yearly intervals. We do repeat evaluations with Mild NCD patients in order to “catch” any progression to Major NCD in order recommend to physicians and neurologists when it may be time to start medications. Knowing the rate of decline, via repeat testing, in a patient with Major NCD can help a family budget time and resources for future care. And when we don’t find evidence of NCD, the testing allows an opportunity to discuss preventive strategies, which are then detailed in our reports.
For the past 25+ years we have offered neuropsychological evaluation of memory and other neurocognitive disorders associated with aging. We no longer use the term “dementia”; instead we talk about a Neurocognitive Disorder (NCD). NCD affects a person’s ability to function socially, manage at work/school, enjoy leisure activities, manage finances, shop and cook, etc. These functions are called Instrumental Activities of Daily Living or IADLs. More basic daily functions like grooming, dressing, eating, toileting and transferring from chair to standing are called basic ADLs.
Neurocognitive Disorders
Neurocognitive Disorders are divided into two categories: Mild and Major. Mild NCD is what used to be called Mild Cognitive Impairment, and many still use that term. Mild NCD involves cognitive changes that affect a person’s instrumental ADLs, but s/he can still manage all of their basic ADLs. The more advanced stage of impairment is called Major NCD and it affects not only IADLs, but also causes impairment in basic ADLs as well. Both Mild and Major NCD can be caused by many factors. An important fact is that while all people with Major NCD previously passed through Mild NCD, not all folks with Mild NCD go on to develop Major NCD. When we “catch” Mild NCD early we’ll discuss preventive strategies to reduce the risk of progression to more advanced cognitive impairment.
Testing compares a patient to their peers in their same age bracket to see if their difficulties are typical, or worse then expected at that age – if worse that can yield a diagnosis of Mild or Major NCD. These changes usually affect memory, word-finding ability, verbal fluency and reasoning/judgement skills which are all assessed in a Neuropsychological (NP) Evaluation. Based on medical history, review of ADLs and test scores we can infer likely causes of Mild and Major NCD; e.g., Alzheimer’s disease. If we don’t find evidence of NCD we look elsewhere for conditions (like anxiety and depression) that might be interfering with memory and functioning.
Why Use Neuropsychological Tests?
There is currently no blood test, X-ray, physical exam or brain scan that can reveal changes in a person’s cognitive status (thinking ability) – which is why we rely on NP testing. Medical exams are important to rule out issues like Lyme disease, hypothyroidism, etc. that could be treated and cured often before going forward with NP testing. This is called ruling out reversible causes of NCD. Your doctor may even order a brain CT or MRI scan to rule out things like brain tumor (which can be treated by surgery or radiation). However, brain scans cannot diagnose NCD, and the atrophy (shrinkage of the brain) that can show up on a brain scan is often normal in aging people. Finally, you may be referred to a neurologist or psychiatrist, who may refer you on to us with specific questions. Since we do different things this isn’t a duplication of services, but instead part of a more comprehensive workup.
Standardized tests are given in exactly the same way, every time, so as to reliably allow us to compare your scores to other people similar to you in age and education to look for NCD, or to rule it out. An important benefit to tests vs. interview is that tests yield numerical scores which can then be used to see improvement/stability vs. decline over repeat testings at yearly intervals. We do repeat evaluations with Mild NCD patients in order to “catch” any progression to Major NCD in order recommend to physicians and neurologists when it may be time to start medications. Knowing the rate of decline, via repeat testing, in a patient with Major NCD can help a family budget time and resources for future care. And when we don’t find evidence of NCD, the testing allows an opportunity to discuss preventive strategies, which are then detailed in our reports.
Let’s discuss how the NP evaluation is done in the Next Section–>
