Aging has its benefits and its drawbacks. Almost all of us will experience them both, either directly in our own bodies and minds or indirectly in those close to us. Whether brought on by age in general or by a specific condition or disease, mental and physical limitations or deficiencies can cause a spectrum of issues from individual confusion to disruption and even danger to a constellation of family and friends.
Without exception, the first need is to understand what is happening. Whatever the number or relationship of people involved, the issues being addressed, or the degree of impairment, clear understanding is the beginning of all solutions. That’s where all my solutions begin: understanding what’s going on.
Although no medication stops or reverses underlying brain damage, I offer evaluations that lead to clearer understanding and strategies to relieve symptoms, improve quality of life, and decrease the burden on caregivers. I help individuals and families adapt to changes related to age and illness by
- Assessing strengths and weakness
- Developing a plan to improve the ability to deal with declines in functioning
- Providing consultation, education, and support to everyone involved in the older adult’s life
The Aging Mind
When older adults have more memory, thinking, or comprehension issues than others of the same age, it’s time to find out why. The changes are not always clear but are nearly always perplexing for the individual in the early stages and for everyone else as the issues progress.
Understanding what an older adult is capable of—and what is beyond their capabilities—is the first step to creating an environment in which everyone involved can be successful and thrive. The first step is a neuropsychological evaluation to determine the individual’s strengths and weaknesses. I work with everyone involved to determine how to use the individual’s strengths to work with or around their weaknesses.
As some older adults decline, their weaknesses may surpass their strengths. When the balance tips toward weaknesses, the external environment needs to be modified to improve success. Understanding that the older adult may no longer be capable of remembering new information, using reasoning and logic to arrive at what would seem to be obvious conclusions, or even appreciating their own deficits is critical to the success of everyone involved in that person’s care.
Mild Cognitive Impairment
Mild Cognitive Impairment (MCI) involves deficits, predominantly memory problems, that are noticeable but that do not significantly affect daily living. They may be bothersome and lead to heavier reliance on written reminders and note-taking to compensate. MCI does not necessarily progress to Alzheimer’s or other dementias.
Signs of more significant problems involve a decreased ability to carry out daily tasks, such as personal hygiene and finances. The diagnosis typically starts with observation and confirmation by a family member or friend. Such signs definitely mean it is time for a neuropsychological evaluation to establish current abilities and to develop a plan to help the individual be more successful in day-to-day life.
Alzheimer’s and Other Dementias
Dementia refers to a cluster of symptoms caused by damage or disease in the brain. These symptoms involve a progressive decline in memory and thinking that interferes with the ability to carry out such important daily activities as driving, shopping, cooking, managing a checkbook, and communicating. Alzheimer’s is the most prevalent dementia in adults over 65. Vascular dementia is similar in effect to Alzheimer’s but is caused by reduced blood flow in the brain.
Each has different features. For example, a person with vascular changes may be able to store new information, yet have difficulty retrieving it when needed without external cues, while someone with Alzheimer’s may not be able to retain new information long enough to store it. Vascular changes tend to happen throughout the brain, except in the case of stroke, while Alzheimer’s can start in specific regions of the brain before it begins to spread. For instance, it can affect language such that communication becomes increasingly difficult to generate or comprehend.
For individuals younger than 65, other neurodegenerative diseases, such as Parkinson’s, Huntington’s, and Frontotemporal Dementia, may account for dementia symptoms that require understanding and treatment beyond the purely medical.
Stroke occurs when blood flow to specific brain regions stops as a result of thickening or hardening of artery walls, or rupture in a blood vessel. Changes in cognitive and physical functioning, which are worst immediately after a stroke, usually improve over time with the aid of speech, occupational, and physical therapy. Pre-stroke functionality may or may not return fully. Residual weakness or partial paralysis can result in ongoing mobility problems. Depending on which side of the brain is affected the individual may have difficulty comprehending language and communicating, or might show impulsive behaviors and lack of awareness of deficits. The practical result is the same need to understand, develop a plan, and follow up as with other, longer-term degenerative issues.
As part of my association with Sierra Nevada Memorial Hospital Stroke Center, I see patients during their in-patient transitional care and when they return home, and work closely with physicians, therapists, and families to achieve the best possible rehabilitation outcomes. Patients in my practice who have completed an outpatient neuropsychological evaluation following stroke are eligible to participate in an ongoing research project to improve cognitive function.
Understanding and clarity start with a neuropsychological evaluation. Fundamentally, it is a means of testing the relationship between brain function and behavior. It provides patient, family, and therapists with invaluable information about abilities and deficits. A neuropsychological evaluation, repeated at appropriate intervals, is useful to monitor progress in recovery and determine achievable rehabilitation goals.
I also offer evaluations of a person’s capacities using standards established by the American Psychological Association and the American Bar Association. Such evaluation can determine an individual’s capacity for decision-making regarding health care, financial, legal, and other important decisions. Capacity determinations include the individual’s overall emotional functioning, ability to live independently, drive, and carry out important daily activities such as shopping, check writing, and meal preparation. For more information see Bonnie’s article in the The Union newspaper.
Capacity evaluation is done following neuropsychological evaluation, which is the required first step to determining an older adult’s mental and emotional capacity for most legal purposes.