Neuropsychology Services

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Neuropsychology Services

96 W. Main Street, Northboro MA

tele:  508-393-3820

fax:  508-393-3814

NEUROPSYCHOLOGY_SERVICES@YAHOO.COM

DEFINITION OF DEMENTIA:

What is dementia?   One suffers from dementia if they have both of the following two symptoms.

1.  First, there is a significant loss of memory compared to others of their age and background. 

2.  Second, there is at least one other serious thinking problem in addition to memory loss.       

Many different brain diseases cause dementia.  To detect dementia when it is in an early stage and the diagnosis is unclear, there is no procedure more sensitive than Neuropsychological testing.  Head imaging studies may, or may not, show changes in early dementia.  But even when an MRI of the head is abnormal it does not clarify the type of problems the person is experiencing.  If you are concerned that you or a loved one may have early dementia your doctor should schedule you for an MRI scan and for Neuropsychological evaluation.

Dementia, Dementia Treatments, Dementia Evaluation and                       Alzheimer's disease here to add text.

LEARNING ABOUT DEMENTIA

Dementia typically occurs either in the "upper" regions of the brain, called the neocortex, or in the lower part of the brain called the brain stem.  Thus the two broad categories of dementia include cortical dementias vs. subcortical dementia.

The "classical" dementia of the neocortex is Alzheimer's disease.  In Alzheimer's disease the first part of the brain affected is called the entorhinal cortex.  Since this brain region is involved with the formation of new memories, the first symptom of an Alzheimer's type dementia is memory loss. 

In the picture below, the "nose" is at the top of the picture and the back of the brain is at the bottom of the picture.   The small area in blue is the entorhinal cortex (and hippocampus).  The entorhinal cortex is needed in order for us to be able to make new memories.  It is the first part of the brain to be attacked by Alzheimer's. 

Later, the area in yellow, called the temporal cortex, is attacked.  This part of the brain is involved in generating and processing language as is the area in green, the parietal cortex.  When these areas are attacked our understanding of concepts, our ability to read, write and do calculations, and the ability to reason through problems is affected. 

In many Alzeimer's patients the area in red, called the prefrontal cortex, comes under attack early in the illness.  When that happens, people have trouble in goal planning, problem solving, organizing their thoughts, and remembering what they "just did".

With our new understanding of the molecular biology of dementia, there have been many new avenues of reasearch that have opened up.  While these are technical and beyond the scope of what I can talk about here, I've included a picture from a recent article that summerizes some of the ways drug companies are now trying to develop interventions to stop the progression of Alzheimer's.  Some of these attempt to break apart the protein that accumlates in the brain, called APP.  Some inhibit the enzymes that produce this protein.  Other approaches have tried to use vaccines to prevent the changes in Alzheimer's disease. 

SUBCORTICAL DEMENTIAS

Diseases such as Parkingson's disease, Huntington's disease and many other subcortical diseases predominantly attack the lower brain region called the brainstem.  These diseases usually have a smaller impact on memory but a disproportionately greater impact on movements, which tend to be abnormal.  The dementia caused by these diseases also is different than what is seen in the cortical (or Alzheimer's like) dementias.  Typically these diseases cause problems in attention and concentration.  They also cause so-called "executive functioning" deficits, which include the ability to organize, problem solve, goal plan, and switch one's mindset between different types of problems.  Finally, subcortical dementia's often affect those brain regions that regulate emotions and can cause signficant emotional changes.

As with the cortical dementia's, Neuropsychological testing is extremely useful in understanding the nature and magnitude of the thinking problems caused by dementia.  Results from Neuropsychological testing can help guide patient's and their families in making decsions regarding the ability to work, the need to obtain entitlements such as disability, and planning out lifestyle changes to adapt to the illness.  Neuropsychological test results also can help guide families and patients regarding their need to seek certain types of treatment that involve memory loss or emotional changes.

Neuropsychology    Services