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When Fading Memory Raises Questions, Neuropsychology Can Point to Answers

10.16.2012

"I know there's a lot more in our future around this, too," said Susan Harvell's husband, Dave Baker. "Every day we just get up and do the best we can, and where we end up is in somebody else's hands."

You can have a quick assessment in a doctor's office—and that's good, but it's not as sensitive as the whole battery of tests you get in a neuropsychological evaluation.

-Stanford neuropsychologist Gayle Deutsch, PhD

Susan Harvell's daughter, Claire, can't list specific moments when her mother seemed to be off her game. "It wasn't anything drastic," she said. "She could tell you a million stories about when I was 3 years old, but if I told her I was going to do something, she'd ask me five minutes later if I was going to do something."

COULD YOU HAVE ALZHEIMER'S DISEASE?

Worrying about Alzheimer's is something more and more of us are doing.  Age-related cognitive decline happens to most of us: As we get older, we might forget why we went into the kitchen or the name of a character in a movie. That's normal. Some of us might do that more than others, but typically, that's about as far as our forgetfulness goes. Here are some basics about Alzheimer's and dementia to consider:

  • Alzheimer's affects short-term memory most dramatically. Asking the same question over and over again is a hallmark of that loss of function.
  • Brain scans might show some physical changes indicative of Alzheimer's, but cognitive tests are the only way to objectively measure functional changes.
  • Memory loss is often accompanied by a loss of executive function: the ability to plan a task and then complete it. Losing the ability to call things by their names is another indicator.
  • Changes in personality also emerge. Someone once very calm and steady may become irritable, sad, anxious, impulsive or apathetic.

What Else Might Cause Cognitive Impairment?

  • Medications, on their own or in combination, may produce dementia-like symptoms. These symptoms can appear suddenly or over time.
  • Thyroid imbalance, hypoglycemia, too much sodium or calcium, dehydration and nutritional deficiencies can also trigger changes in cognition and emotional state.
  • Brain tumors and bleeding between the brain and its lining can interfere with brain function; so can lack of oxygen to the brain, originating with heart and lung problems. Other health issues, including smoke or carbon inhalation or coma, can have an impact on brain function.

What Tests Can Help

  • Physical exam, including blood and organ function tests, along with a complete medical history, is helpful in ruling out a treatable medical condition.
  • MRI, CT and PET scans provide more detail; an EEG (electroencephalogram) tracks electrical activity in the brain through electrodes attached to the scalp. Spinal fluid may also be tested.
  • Neuropsychological and psychiatric evaluation complete the picture.

Having an answer helps a patient understand more about their prognosis and what's likely to happen in the coming years—and we have a lot of data and understanding about that.

-Stanford behavioral neurobiologist Geoffrey Kerchner, MD, PhD

"Having a garden and a dog is really healthy if you're going through something like this," said Susan Harvell. "I read. I paint. I have things to do. I have great friends."

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