How often do you walk into a room and completely forget why you went there? Or do you struggle with remembering someone’s name a few seconds after you are introduced? It seems that these “senior moments” occur more frequently as we age. As a clinical neuropsychologist, I am often asked if this is normal aging or if it is a sign of a bigger problem such as Alzheimer’s.
The field of neuropsychology is uniquely skilled to answer this question. Clinical neuropsychology is a sub-field of psychology that examines the relationship between the brain and behavior. It uses neuroscience, neuroanatomy, cognitive psychology, cognitive science and clinical psychology to understand the structure and function of the brain in relation to behavior and the information processing aspects of the mind. Neuropsychologists help to assess, diagnosis and treat individuals with neurological, medical, developmental or psychiatric conditions across the lifespan.
Neuropsychological testing can aid in understanding how different areas of the brain are working. Neuropsychologists use standardized tests to examine a person’s strengths and weaknesses in all areas of cognition. Areas of cognitive impairment can be identified and placed within the context of the individual’s medical and psychological history in order to determine what condition may be impacting a person’s functioning.
Testing is typically requested when individuals or family members notice symptoms involving memory. A person’s performance on each test is compared to those who are similar (e.g. same age, level of education, etc.) to decipher whether there are areas of thinking that are poorer than would be expected as compared to the person’s healthy peer group. A neuropsychological evaluation assesses all areas of thinking, including but not limited to:
- General Intellect
- Attention and Concentration
- Language Skills
- Visual-spatial Abilities
- Motor and Sensory Skills
- Learning and Memory
- Executive Functioning (e.g. reasoning, problem solving, etc.)
- Mood and Personality
Neuropsychological testing is sensitive to mild changes in thinking that might not be obvious in casual situations. Testing can identify whether changes are normal age-related changes or whether they are related to a medical condition. Different conditions can manifest themselves in various patterns of cognitive strengths and weaknesses on testing that can then aid in determining the most appropriate course of treatment. For example, testing can demonstrate different patterns among Alzheimer’s disease, stroke or depression. Once the cause of the deficit is identified, then specific treatments can be chosen by the healthcare team.
Current trends in the field involve neuropsychologists focusing on individuals with specific conditions. For example, neuropsychologists assist athletes with identifying whether they have experienced cognitive problems secondary to sports-related concussions and whether they should return to sports. Attention difficulties can be examined to determine whether they are consistent with Attention Deficit/Hyperactivity Disorder or other conditions such as depression or anxiety.
Neuropsychologists who work with older adults can answer whether cognitive problems are secondary to normal aging or various dementias such as Alzheimer’s. Approximately one in eight older Americans has Alzheimer’s disease, and memory and cognitive changes are the most prominent early symptoms. Neuropsychological testing can provide concrete data as to the severity of cognitive impairment caused by Alzheimer’s. In addition, neuropsychologists provide recommendations to individuals in regards to planning for future cognitive decline.
Often individuals are not sure what is causing their problems yet they know that something is not going well with their thinking. Neuropsychological testing can help with determining:
- Does cognitive impairment exist?
- Does the pattern of impairment in the context of the person’s history suggest a diagnosis?
- What are the real-life consequences of this impairment (e.g. need for assistance, medication, etc.)?