senior with depression

A common source of concern for older adults presenting for an evaluation of memory loss is fear that they have Alzheimer’s disease (AD). However, confusion often surrounds this diagnosis as many assume that AD and dementia are one and the same. While AD is a form of dementia, there are many other types of dementia, each of which have different ways of presenting, as well as differing courses of illness and prognoses.

Dementia is an umbrella term analogous to the term cancer. A cancer diagnosis is very broad, it doesn’t tell you what kind of cancer it is, its origin, or its prognosis. For example, a diagnosis of brain cancer has quite different implications than skin cancer in terms of how symptoms initially present and what the long-term outcome might be. The same holds true for dementia. This diagnosis, in simple terms, means that an individual is experiencing changes in their thinking abilities that are above and beyond normal aging, and these changes are now affecting their ability to complete daily tasks independently. These changes may be the direct result of a medical condition (e.g., dementia due to a traumatic brain injury or HIV, among others) or may be due to an underlying neurodegenerative process. For many older adults, their dementia is more progressive in nature, with a neurodegenerative process being the cause of these changes. In addition to AD, Fronto-Temporal Dementia (FTD), Lewy Body Dementia (LBD), and Vascular Dementia (VD), among others, are forms of neurodegenerative dementia.

Each form of neurodegenerative dementia has its own unique pattern of symptom presentation and cognitive profile. In AD, the most common symptoms are increasing episodes of forgetfulness (e.g., poor recollection of recent conversations) and word-finding problems (e.g., calling an object by the wrong name). It is important to note that these difficulties are common in older adults; however, they become more alarming when they begin to occur more frequently over time, interfere with daily tasks (e.g., paying bills, driving, etc.), and are of greater severity than one’s peers.  Another form of dementia, FTD, tends to present earlier than AD (i.e., before age 65) and the most common form of this disease is characterized by marked behavioral and personality change. In these cases, individuals may become more disinhibited, impulsive, or apathetic. In LBD, new onset visual hallucinations and parkinsonism (e.g., rigidity and motor slowing) are characteristic of this disease, while more diffuse impairments in cognition may be present in VD. These are just a few examples of the many forms of dementia that could be accounting for one’s difficulties in daily life.

A neuropsychologist is an important member of the team of doctors who assess and treat those with dementia. The neuropsychologist’s role is to assess an individual’s cognitive strengths and weaknesses, as well as help clarify a diagnosis, and make appropriate treatment recommendations. A typical evaluation includes an in-depth clinical interview with the patient and family member to gather information on difficulties that are being noticed in one’s thinking abilities and day-to-day functioning, as well as their general background information and personal history. One-on-one testing would follow to formally and objectively assess a patient’s cognitive skills, with their test data then being compared to their same-aged peers. All of these data are integrated into a comprehensive evaluation with the aim to help answer patients’ concerns. Recommendations to the patient, their family member(s), and their treating providers are also included with the goal to help patients receive the appropriate care and follow-up, as well as supports, to continue to enjoy a high quality of life.

Additional Resources:

Alzheimer’s Association: www.alz.org

The Association of Frontotemporal Degenerations: www.theaftd.org

Lewy Body Dementia Association: www.lbda.org

National Stroke Association: www.stroke.org

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