Early Detection of Cognitive Disorders

Robin J. Heinrichs, Ph.D., LP Neuropsychologist & Assistant

Professor Director of Neuropsychology Laboratory

Thinking All the things our brain does to help us do

things, learn things, and verbalize and understand others.

What is cognition?

Comprehension Verbal fluency Solving problems Switching

between tasks Abstract thinking Sequencing

activities

To name a few …

Learning Memory Attention Speed of

processing Visuospatial

abilities Planning

Processing speed … influences … Attention Word-finding Memory Cognitive flexibility

Less efficient at learning new information Therefore poorer recall 30 years and after …

Does cognition change with age?

Not impairment Noticeable Annoying Function fine

Normal/typical aging

Decline is worsening Interferes with functioning Others around us concerned

What could this be? Dementia

When to be concerned?

Dementia is an enduring decline in cognition that interferes with functioning in everyday living.

American Psychological Association

What is dementia?

Dementia is an enduring decline in cognition that interferes with functioning in everyday living.

American Psychological Association

Changes are worsening, often gradually over time Different types of dementia follow different

patterns of decline

Dementia is an enduring decline in cognition that interferes with functioning in everyday living.

American Psychological Association

Some portion of cognitive abilities have declined Pattern of decline varies depending on the cause Decline is in more than one area of cognition

Dementia is an enduring decline in cognition that interferes with functioning in everyday living.

American Psychological Association

The change in cognitive functioning must be severe enough to make it harder for the individual to carry out activities of daily living Managing finances Managing medication Maintaining a calendar and going to appointments

on time Preparing meals

If decline in cognitive abilities and difficulty functioning are severe enough = Dementia

Cognitive decline that is 2 standard deviations below previous

Decline in more than one cognitive domain

A diagnosis of Dementia does not tell you what is causing the decline.

Dementia is a general diagnosis

Dementia can be caused by many diseases and pathologies that have affected the brain.

Knowing the cause tells us what to expect in the future.

Allow the individual to plan and make decisions for themselves before they are unable to do so

Allow the patient and family to ensure safety and well-being over time

Future – hope is that treatments will be found to intervene early in the disease (pre-clinical)

Early detection benefits

Alzheimer’s disease Frontotemporal disease Vascular disease Parkinson’s disease Lewy body Other

Types of dementia

The best method of early detection of Alzheimer’s disease and other dementing processes is Neuropsychological assessment.

4 years before diagnosis Poorer memory for new information than

others same age = Alzheimer’s diagnosis later

Alzheimer’s disease (AD)

Best Predictors of AD – Preclinical Stage Naming & fluency Verbal memory Abstract reasoning

Gradual decline in memory for new = Best preclinical predictor

Clinical AD cognitive impairments: Learning and memory Trouble naming and verbal fluency Visuospatial abilities Carrying out tasks (apraxia) Executive functioning (problem-solving,

sequencing, set-shifting, concept formation, abstract thinking)

Lack of awareness of impairment (agnosia)

AD is a disease in which nerve cells in the brain degenerate and die

Historically the disease was identified by amyloid plaques and neurofibrillary tangles in the brain upon autopsy

Today we think this is late in the disease and these are found in brains without AD

Research continues with promise

First notice trouble remembering things - May repeat the same questions or stories

Damage to the temporal lobe of brain

Temporal lobe

The frontal lobe experiences damage next.

This causes problems with executive functioning. Focusing Multi-tasking Problem solving Staying on track with a task Switching between tasks Abstract thinking Comprehension of complex

information

Frontal lobe

Course of AD: Gradual decline in abilities Increasing need for assistance

First with independent tasks - finances and medication management

Then daily tasks like dressing and bathing Course of disease varies and can range from

six to fifteen years.

Caused by degeneration and death of nerve cells within the frontal lobes and the temporal lobes. In general caused by loss of neurons and

abnormal amounts or forms of tau proteins in the brain.

FTD is relatively difficult to diagnose as a decline in memory is not associated.

Instead, executive functioning abilities decline.

Frontotemporal disease (FTD)

Executive functioning changes: Focusing without distraction Planning and sequencing Solving problems Comprehending complex information Multitasking Focus on unimportant details and missing the big

picturePersonality changes Often looks like a psychiatric disorder

FTD looks different

Of all changes, changes in personality are often the most upsetting to families Failure to inhibit inappropriate behaviors, e.g.

loud, rude comments in front of others that do not bother the patient

Inappropriate sexual comments to others Flattened reaction to emotional events, e.g.

when spouse is upset they do not react OR … more easily irritated or upset, more often

tearful

Primary progressive aphasia

Form of FTD Trouble coming up with what you want to say. Difficulty finding the right word. Pronunciation problems. Paraphasia; saying words that sound like the one

you want. Trouble reading. Difficulty writing.

Course of FTD: Gradual decline in cognitive and functional

abilities Gradually increasing need for assistance

with tasks Because trouble carrying out tasks is primary

difficulty, assistance is often needed earlier in the disease

Course varies from several years to ten years.

Vascular dementia is caused by cerebrovascular disease through any insult to the brain by blocked blood flow or a bleed within the brain. Terms used include: stroke, transient ischemic attack

(TIA), hemorrhage, ischemia, embolism, thrombosis, infarct

These events cause brain cells to die in the affected areas.

This causes cognitive deficits that coincide with the area of insult.

Vascular dementia

For example, if a blockage or bleed occurs in certain areas of the left hemisphere, patient will have difficulty speaking or understanding what is said.

The bigger the area of insult the more cognitive damage.

The longer the anoxic insult or the bleed, the greater the cognitive decline.

Important! Cognitive decline in vascular dementia is more sudden

than AD or FTD. Insult … then cognitive decline … then some recovery …

left with enduring deficit Step-wise decline

If no more vascular insults occur cognitive abilities will not decline more.

BUT … past CV disease makes future CV disease more likely.

Parkinson’s disease – not all incur cognitive decline

Huntington’s disease Multiple sclerosis Lewy body disease Anoxic insult

Other causes of dementia

Patient or family mention … 1. Personality change

More irritable More laid back Tearful Disinhibited Lack of motivation, interest in things Lack of awareness of any deficits

2. Difficulty getting along with others3. Work is harder now4. Poor review or criticism from boss at work

Signs to look for

5. Takes longer to figure things out6. Patient stopped fixing things around house, quit

using computer, etc.7. Patient stopped reading or other activities they

used to do8. Financial problems, late bills or trouble with bank9. Car accidents or tickets; doesn’t like to drive

now10.Repeating themselves or asking others the same

questions; forgetting

Schedule a neuropsychological evaluation KUSM Memory and Cognition Clinic

293-3850 7829 E. Rockhill, Wichita KS 67206

Then what?