About Memory Testing

Neuropsychological Evaluation:
For the past 20+ 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 or 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 call 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
We divide Neurocognitive Disorders 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 or most of their basic ADLs. A 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.

Testing compares a patient to other people in their same age bracket to see if their difficulties are typical, or worse then expected at that age – which can then 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, test scores and their patterns we can infer likely causes of Mild and Major NCD; e.g., Alzheimer’s disease. If we don’t find evidence of NCD we can look elsewhere for conditions (like anxiety and depression), and then treat those issues helping patients improve 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 performed first, in order to rule out issues like Lyme disease, hypothyroidism, etc. that could be treated and cured before going forward with NP testing. This is called ruling out reversible causes of NCD. Your doctor may 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 sees you first and then may refer you on to us with specific questions which helps us narrow and focus our NP evaluation. Since we do different things this is not a duplication of services, but instead results in a more comprehensive workup. So we see this as an advantage.

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 vs. stability vs. decline over repeated testing at yearly intervals. We do repeat NP 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 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.

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