Transcript A.J. Zolten, Ph.D. - Arkansas Academy of Family Physicians

A DEMENTIA PRIMER: WHAT TO LOOK FOR, WHO TO
ASK AND WHAT TO DO
A.J. ZOLTEN, PH.D.
Director of
Neuropsychology and
Psychology Services
8 Shackleford Plaza, #201
Little Rock, AR, 72211
Office: 501-219-8999
Fax: 501-219-8544
MEMORY DECLINE HAS A PREDICTABLE
COURSE
Memory functioning is
stable during Early
adulthood.
Modest declines in memory
after age 40 are not
uncommon.
Changes occur in mental
flexibility with age.
Complex learning functions
are the first to go.
Memory decline becomes
more dramatic in later years
Memory problems evolve
into dementia
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DEFINING DEMENTIA AND
ALZHEIMER’S DISEASE
Dementia is like Heart Disease
1.
2.
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There are different kinds of dementia just like there
are different kinds of heart problems.
Alzheimer’s disease is a type of dementia, just like
coronary vascular disease.
Alzheimer’s disease is the most common cause of
dementia
Vascular dementia is the second most common cause
of dementia
MOST COMMON SYMPTOMS OF
DEMENTIA
MEMORY
DISTURBANCE
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Recall of previously learned
information
Inability to access long-term
memory on demand
Inability to learn new
information
Excessive and/or rapid decay
of new information
OTHER PROBLEM
AREAS
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Motor coordination
Language
Insight
Decision making and
problem solving skills
Changes in Personality
Functioning
AGING OR ALZHEIMER’S?
ACTIVITY
AGING
Forgets
Parts of
experience
Remembers later
Often
Rarely
Follows written or
spoken directions
unable
Usually able
Gradually
Usually able
Gradually
Can care for self
unable
ALZHEIMER’S
Whole
experience
FUNCTIONAL ASPECTS OF DEMENTIA
Dementia Means that the
patient can no longer
function independently
Finances
Home upkeep
Community Activities
Activities for Daily Living
Medication Management
Driving/travel/transportation
DIAGNOSIS OF DEMENTIA:
WHO AND HOW
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Primary Care Physician
Usually the front line of elder care
Usually a brief examination of cognitive functions (MMSE)
Usually refers to a specialist
First Line Specialists-Neurologists/Psychiatrists
Inventory of symptoms is more thorough
Cognitive examination should be standard (still MMSE)
Refer to Dementia specialist
Dementia Specialists-Gerontologist
Rule out alternative diagnoses
Integrate medical history
Integrate psychosocial history
Get appropriate neurodiagnostic imaging
Get Neuropsychological test data
Dementia Specialists-Neuropsychologist
Thorough evaluation of memory and cognition
Integrate psychosocial history
KEY ISSUES IN PSYCHOSOCIAL
ASSESSMENT FOR DEMENTIA
PSYCHOLOGICAL
ISSUES

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Premorbid intelligence
Educational attainment
Work History
Past/current level of
independence
Psychological adjustment
Treatment history
Current mental health status
SOCIAL ISSUES

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Family history
Marital issues
Economic status
Psychosocial support
Community integration
MEMORY FUNCTIONING IS AFFECTED
BY ENVIRONMENTAL FACTORS
Stress from job, family, social life,
obligations, changes etc.
Depression, anxiety, other mood
disturbances
Inattention due to multiple
demands in the environment
ESSENTIAL FEATURES OF
NEUROPSYCHOLOGICAL
EVALUATIONS
General Cognitive Abilities-WAIS-4

Vocabulary, Abstraction, Problem Solving, Attention, Fund of Knowledge,
Nonverbal Reasoning
Memory-WMS-4

Historical, Auditory, Visual, Working,
Orientation

Person, Place, Time, Reason for Visit
Language

Naming skills, Fluency
Executive Skills
Motor Skills
COMMON REASONS FOR
MISDIAGNOSIS

Polypharmacy/medication side effects
 Depression or other psychiatric diagnosis
 Misdiagnosis of psychiatric condition with
poor treatment choice
 Lack of appropriate medical diagnosis
(condition not recognized)
 Lack of appropriate medical treatment
BENEFITS OF ACCURATE
DIAGNOSIS AND TREATMENT

Early intervention with the appropriate
treatment modalities
 Extending independence and quality of life
 Allowing research to catch up with
progression
 Activating psychosocial support
 Giving time to plan for the future