Evaluation Of Seniors
People with a parent or sibling who had DAT, especially if it onset at an early age, are at more risk of developing the disease. There are several other factors that increase the risk of DAT and other illnesses leading to dementia. These include, but are not limited to, problems with circulation arising from high cholesterol and/or high blood pressure, diabetes mellitus, and a history of moderate or severe traumatic brain injury.
Dementia-Alzheimer’s Type (DAT). The human brain has tens of billions of neurons each of which is connected to thousands of other neurons. Unlike muscle, bone or skin cells, neurons are not ever replaced so throughout our lives we have fewer and fewer neurons as neurons die and are not replaced. Because we have so many neurons these losses only start to become noticeable as we move into old age. In DAT, this gradual loss of these neurons and their connections accelerates. In recent years it has been discovered that there is also a progressive accumulation of different types of proteins (amyloid and tau) in the brain which may account for the accelerated cell death. In the early stage of the disease, these changes generally affect parts of the brain that are associated with our ability to learn and retain new information. Therefore, the first symptoms generally consist of memory problems or rapid forgetfulness. As the disease progress, the pathology in the brain spread to other regions, which leads to other changes in thinking skills, behaviour, and in personality. These may include increased apathy and/or irritability, word finding difficulties, social withdrawal, socially inappropriate behaviour, and increased difficulty managing finances.
Vascular Dementia. Vascular dementia consists of cognitive decline that occurs because of problems with our vascular or circulatory system in the brain. This may result from a single event, such as a major stroke or the gradual accumulative effects of dozens or even hundreds of very mild strokes. A person with vascular dementia tends to show a more rapid onset of symptoms compared to what is seen in DAT. How quickly it progresses depends in part on when it is identified and whether contributing factors to the strokes, such as high blood pressure, can be controlled. The cognitive deficits associated with vascular dementia largely depend on which area of the brain was affected by the disease or the event, and hence are more variable in nature than those seen in DAT.
Frontotemporal Dementia or Frontal-Temporal Lobar Degeneration (FTLD). The term FTLD refers to the regions of the brain that are mostly affected by the disease (the frontal and temporal lobes of the brain). It is estimated that Frontotemporal dementia-spectrum disorders account for up to 20% of all pts with degenerative dementias. The condition typically presents between the age of 45 and 65 years old. Genetics factors remain at this time the only known cause for FTLD. We also know that there is a certain amount of overlap between patients with FTLD and patients with motor disorders, such as motor neuron disease (MND) or Amyotrophic Lateral Sclerosis (ALS). It can be difficult to distinguish between DAT and FTLD as both diseases share a number of similarities, such as insidious onset and progressive difficulties with memory and language. Personality changes, such as appearing more indifferent or depressed or being more socially inappropriate or careless can also occur in both DAT and FTLD, but in DAT these changes usually occur at a later stage in the disease compared to FTLD. There are several types of FTLD, which essentially depend on the regions in the brain that are predominantly affected. The most common type of FTLD is called the Behavioral variant of FTLD and involves primarily personality and behavioural changes. It accounts for approximately 56% of all FTLD and progresses relatively rapidly (an estimated time of 3.4 years from diagnosis to death). Other variants of FTLD start with a decline in a person’s language skills or a person’s ability to express himself/herself and/or to understand what other people are saying.
There are different subtypes of MCI, depending on the kind of cognitive impairment the person has. For example, some people have specific difficulty memorizing new information while other thinking skills, such as their ability to focus their attention or express themselves will remain intact, whereas someone else may experience significant problems finding words and so on.
First, although there is no “cure” for DAT or many other dementias there may be things that can be done to slow or reverse the progress of the dementia, such as reducing high blood pressure in vascular dementia. There are medications, such as Aricept or Exelon that are used to potentially delay the progression of dementia. Although these medications are of limited effectiveness, ongoing research is likely to lead to their improvement in the future. In addition, leading a healthy lifestyle by controlling your cholesterol level, keeping a normal blood pressure, avoiding smoking or maintaining normal blood sugar levels can help lower the risk of developing dementia. Physical exercise and mental stimulation are also increasingly considered to be protective factors for our cognitive health.
Second, if the individual does have a progressive dementia an early diagnosis gives that person and his or her family more time to come to grips with this reality and make decisions about how it will be dealt with by all involved. Likewise, even if the dementia can’t be reversed or slowed there are treatments that can reduce some symptoms that accompany dementia and thus improve the patients’ and their families’ overall quality of life. Psychotropic medication for example may be used to treat depressive or anxiety symptoms. Likewise, behavioural therapy with the patient and his or her caregivers may help them to better manage behavioural problems.
What about alternative treatments like computerized brain-games, neurobiofeedback or naturopathic approaches?
Our Seniors’ Neurocognitive Assessment Program (SNAP)
The term cognitive functions refers to a group of skills or abilities that our brains use to make sense of information, analyze that information and decide what to do about it. In everyday language, these functions include our use of, seeing, hearing, and other senses to tell us what’s going on in the world, our use of concentration, memory and reasoning to make sense of it, and our use of judgment to develop plans to act on it.
As we age, our cognitive functions, just like our senses of sight and hearing, become less acute. This is perfectly normal. However, as we age we also become more susceptible to illnesses that can impair our cognitive functions. Some, like drug side effects, hypertension or depression can be treated and others, like some forms of dementia, cannot.
Many of these illnesses are not identifiable by standard medical tests like blood tests or x-rays. Instead, the earliest warning sign of many of these disorders is what is known as Mild Cognitive Impairment or MCI. MCI is the disruption of these cognitive functions that is over and above what is due to normal aging but is still fairly mild. Simply put, as we age, we and/or those around us are often quite aware that we don’t remember things or think through decisions as well as we used to. The question is, how do we tell if that’s just normal aging or MCI? One of the most effective ways to differentiate normal aging from MCI is to perform a Neurocognitive Assessment.
Although most health care services are billed on an hourly basis, because cost is a significant issue for people our program involves a flat fee of $1,500 so you won’t have any unpleasant surprises at the end of the process. MSP does not cover psychological services, but part or all of the cost may be covered by extended health insurance.
Dr. Schmidt is board certified in clinical neuropsychology and clinical psychology (ABPP) and has practiced neuropsychology for over 40 years in a variety of hospital, rehabilitation, and private practice settings.