Obtaining a Memory Assessment and the Role of a Neuropsychologist in Memory Care

Subscribe to this podcast through iTunes, Spotify, Podbean, Stitcher, or Google Play Music.

Transcript

Nathaniel Chin: Welcome to Dementia Matters, a podcast created by the Wisconsin Alzheimer's Disease Research Center. It's our goal to humanize Alzheimer's research so that our community, our patients, our participants and anyone else interested, can get a better understanding of the work that's happening to fight back against this disease. My name is Nathaniel Chin and I'm a geriatric and memory clinic physician at the University of Wisconsin. I'm also the family member of someone living with dementia. I'll be serving as your host for this podcast and asking the questions I believe on the minds of many in our community. Thanks for joining us.

Welcome to Dementia Matters. Our guest today is Dr. Lindsey Clark, a neuropsychologist with the UW Health Memory Assessment Clinic. As a neuropsychologist, Dr. Clark has specialized training and understanding the health changes that can affect a person's behavior and personality. I'll start out today by asking you Dr. Clark, what is the memory assessment clinic from your perspective?

Lindsay Clark: So the memory assessment clinic primarily sees patients who have concerns regarding memory changes that occur with aging. People are often referred because there's a concern that they may have dementia, they may have mild cognitive impairment and maybe Alzheimer's disease, or they had a stroke or for some whatever reason, they're having memory changes. And usually they report that to their primary care physician and their PCP, then refers them to the memory clinic to do a more thorough assessment of exactly what changes are occurring, how long have those changes been going on, and whether they're consistent with some sort of neurodegenerative disease, so whether they meet criteria for dementia or where they're likely to progress to something like dementia.

Chin: So when you meet with these patients who have memory concerns, obviously you will ask a whole long list of questions about that. But for the rest of us who aren't a neuropsychologist, do you have some key questions that we should ask?

Clark: Yeah, I think it's important to understand kind of the onset of the symptoms. Did they come on suddenly? Did they come on more gradually? Was there something going on in their life that happened when these symptoms started to occur? Were they grieving the loss of a loved one? Were they having depression? Did they just recover from surgery? You know, with something else going on in their life at the time those symptoms started? So getting more information about the onset of the symptoms as well as sort of the course of the symptoms. You know, had they been pretty stable? Do they feel like they were progressively worsening? Were the symptoms present and then they actually improved over time? So maybe the person had some sort of head injury, had cognitive symptoms, but now once they get to our clinic they've actually started to resolve. So those things are really important questions in terms of the course in the onset in order to try to differentiate between what might be causing the symptoms and what the prognosis might look like over time.

Chin: Is there a particular memory complaint that is more concerning or less concerning when it comes to looking at a true deficit?

Clark: That's a really good question. I think some complaints, I can immediately think of some that are less concerning. So when people report, for example, walking into a room and not remembering why they did that, but then being able to remember it a few minutes later or sort of retracing their steps and being able to figure it out. That's usually not a significant concern. That's a pretty common complaint that happens with normal aging. More concerning is when people are reporting difficulties doing things that they've never really had trouble with before. So for example, if someone is pretty used to managing the household finances, but are you know noticing that for whatever reason they are writing out the checks incorrectly, or they missed a payment and they got a late fee and that's never happened before, or you know, maybe they're driving and they suddenly don't know where they are and they've become lost and they know this route relatively well. Those are things that become a little bit more concerning.

Chin: I'm going to put you on the spot because I know this is kind of a gray zone, but I hear so many older people say I'm having a hard time finding the words that I used to find. Is that a harbinger of dementia or is that something that we experienced as we get older?

Clark: That's actually a pretty common thing that people experience when they get older. Part of the issue is that people, when they get older, one of the most common components of normal aging is slowed processing speed and with that comes slower retrieval of information from memory. So it can take longer for older adults to find the word that they're looking for, find the information that they're looking for. But if you give them enough time, they can usually retrieve it within a few seconds. It becomes more concerning when a person really can't have a conversation because that word finding problem has become so overpowering. So when a person really has a significantly slowed rate of speech because their word finding deficits, that's where it becomes kind of crosses over from the normal aging, to concerning. As well as when people use the wrong words, so like going to say the word giraffe, but instead saying like zebra or staying like just animal that you can't find the right word. That's when you start worrying about their semantic network, which can be affected by something like Alzheimer's disease.

Chin: Now, what do you think of people going online with memory concerns and taking some sort of free online tests and being told they have dementia?

Clark: I don't think that's a good strategy. I don't think that's very comprehensive. There's a number of reasons why people can perform poorly on a cognitive screener or um, like a online test. We also don't really know if those are validated, I guess, and whether there's specific norms for specific populations for those tests. So on the test that we use, we have a large normative database that's available for each test to see, you know, how people normally perform when they're between the ages of 18 and 89 for example. Or how they normally performance ages 50 to 59. So we can see if someone's outside of the range of normal performance. Whereas you know, on those online tests or you know, a screening measure, there might just be kind of a cutoff for everybody, but we don't know if that cut off is specific for that person. Their educational background, their age, their ethnicity, they might be anxious when they're taking it and so maybe they do more poorly on some of the tests than they would if they weren't anxious, and so I think it's important to have at least somewhat of a thorough assessment of the cognitive symptoms that someone has to see, you know, what might be contributing to their complaints.

Chin: And that makes sense that the tests you use have lots of data and science to back them, whereas others, especially the free ones, but the ones online may not, but then the screeners, because you use the word screener a few times, can a stranger tell me if a person has Alzheimer's disease?

Clark: It really can't. No, a screener can... a screener can be helpful in trying to see if someone has cognitive complaints, how severe those kinds of cognitive complaints are in general. It can help to detect dementia for example. They're not very sensitive to mild cognitive complaints like mild cognitive impairment. So people with MCI might perform perfectly on those tests, for example. People might perform in a dementia range on those tasks and not have Alzheimer's disease, but maybe be really depressed or maybe have some other reason why they're performing poorly on those tasks. There's also people who only have like eight or 10 years of education and those people tend to perform much more poorly on those cognitive screeners and so just because they're in the dementia range, it doesn't mean they have Alzheimer's disease. It's more just kind of a red flag that this person probably needs to be more thoroughly evaluated to see if they have cognitive symptoms and what might be causing them.

Chin: In addition to diagnosing people, you also can provide treatments and interventions. Can you tell me about that?

Clark: Yeah, so as a clinical psychologist, I'm trained both in assessment, neuro-psych assessment specifically, but also in interventions like cognitive behavioral therapy for things like depression, anxiety, insomnia, those kinds of things. For people with memory complaints specifically. I'm also working in a couple of clinics looking to provide more intervention services for people with dementia specifically. Once people receive a diagnosis of dementia, helping to develop strategies using their cognitive strengths to kind of guide what they can do in the future, helping to identify their specific cognitive weaknesses and use those to develop a more specific compensatory strategies for their day to day life so they don't have to like use their memory as much if their memory is impaired. And then also helping to provide some strategies for coping with the diagnosis of dementia so people are less likely to develop depression, for example, on top of dementia.

Chin: Well, thank you for joining us today and I appreciate you providing this information.

Clark: You're welcome.

Credits: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the geriatric research education and clinical center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and recorded and edited by Alex Wehrli. Our musical jingle is "Cases to Rest," by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.