Transcription:
Care For Aging Parents: What Is Normal Memory Loss And When Should We Be Concerned?

Melanie Cole (Host):  You may have noticed your parent is forgetting things or repeating the same story. How can you tell if these changes you're seeing are a part of the normal aging process or if it's a symptom of something more serious? My guest today is Dr. Gale Risse. She's a Clinical Neuropsychologist and Director of the Psychological Services at Minnesota Epilepsy Group. Welcome to the show, Dr. Risse. Tell us a little bit about your specialty of neuropsychology? What does that mean for the listeners?

Dr. Gale Risse (Guest):  Sure. And thank you for having me, Melanie. A neuropsychologist is actually a doctoral level psychologist who has a specialty training in the neurosciences and in the evaluation of cognitive brain functions; things such as memory, problem solving, attention and overall intelligence. These functions can be affected to varying degrees by neurological disorders that directly affect the brain. Some examples of that would be things like epilepsy, dementia, stroke, head injury, brain tumors and many other conditions. The neuropsychological evaluation consists of a series of cognitive tests and they are administered on a 1:1 basis by a trained examiner. Mostly, we use a question and answer format and sometimes, visual motor performance tasks. For example, a patient may be asked to memorize a list of words by practicing the list a number of times or identify a pattern in a visual puzzle. A comprehensive exam can take several hours to complete with breaks depending on the question that's being asked and depending on the stamina of the patient. The test results are then interpreted by a neuropsychologist who can provide information about general efficiency of mental functions overall and also identify any specific cognitive deficit, such as poor memory for faces or a loss of spatial judgement and many other specific functions. We know that some of these functions are located in specific regions of the brain. If we can discover a particular deficit, it may actually help us to pinpoint the problem area.

Melanie:  So, what does your specialty have to do with this aging population that we are seeing today? It's such a growing population. So, how is neuropsychology involved in the aging population?

Dr. Risse:  Well, a number of these cognitive functions change quite a bit during the normal aging process. Some of these changes include things like slower motor responses, changes in mental speed and efficiency and mild memory decline. These problems can also be made worse by problems with vision or hearing. These age-related changes typically occur very slowly over a number of years. I often see patients who come in in their mid-fifties who are beginning to notice changes and may have concerns. The tests that the neuropsychologists use take these changes into account so that a normal performance for a woman in her 80s, for example, may be quite different from a normal score for a 25-year-old. The tests that we use have been tried out on large numbers of people in every age range so we have a pretty good idea what is normal for a particular age and education level. In a typical evaluation we are always looking for scores that fall outside the normal limits, especially if they can form a pattern.

Melanie:  So, if someone is noticing changes in a loved one and maybe they are normal for their age or they are symptoms of something more serious, what are some of the red flags you would like to let listeners know to watch out for that would send them to see somebody with their loved one to get these things checked out as to whether they are a normal part of aging? Please give us some red flags that people can look for.

Dr. Risse:  Sure. I think this kind of judgement can be very difficult for family members because there is so much in the media that people hear about dementia or about Alzheimer’s disease and it's possible that sometimes a family member may overreact and they may see a behavior that's really normal for age, like misplacing your keys or trouble locating your car at the mall, and be concerned that this may represent a disease process. But, in fact, the early stages of Alzheimer’s disease or other forms of dementia typically involve more extreme changes in behavior. So, some examples of this would be frequent forgetfulness to the point that it's actually causing practical problems in daily life, or extreme repetitiveness in conversations--not just occasionally retelling a story that was told at a previous family gathering, for example. Getting lost or confused when driving. It can be a change in personality or some kind of a decline in the patient's routine and personal grooming habits. So, any of those things that really look different from the way that person would normally function. 

Melanie:  So, if somebody notices these kinds of things--and I've had so many older relatives, Dr. Risse, that I see these things that you're describing so often. When you notice these things who do you go see first? Do you go to an internist? Do you go to a neuropsychologist? What is involved? How do you get an evaluation?

Dr. Risse:  I would suggest that the first thing to do is to bring it up with the primary care provider. So, a concerned adult child, for example, could go with their parents to their primary care appointment and bring it up at that time. Some doctors may choose to do an evaluation on their own and others may feel the need to refer to a specialist. That specialist could be a neurologist who might perform lab studies and other tests to examine whether this might be the beginning of a dementia and it could be a neuropsychologist. Very often, the neurologist will then, as a next step, refer to a neuropsychologist. It's also possible to make a diagnosis of dementia or to determine the genetic risk of dementia with some very exotic laboratory tests and certain kinds of brain imaging. But, it's important to remember that these procedures are still quite expensive, they may not be covered by insurance and they are really not yet widely available. So, to understand what's going on, the degree of loss, and whether the behavioral changes seem to be in line with the diagnosis of dementia, I think the neuropsychological testing is really still the most accurate method. Another thing to remember is that this testing does require that the patient be completely cooperative and willing to participate in all aspects of the exam. It's very helpful for a close family member to accompany the patient to this exam in order to provide additional details about the specific symptoms of concern, the history and when the changes were first noticed.

Melanie:  So, how do you approach your elderly relative if this is something that some people take offense at? They say--and I know people this has happened with—“I'm not having issues. I'm not forgetting things. No, that's not me, I'm not going through those things.” How do you approach the person and get them to go with you to see somebody to discuss this?

Dr. Risse:  This can be very tricky and I think all of us with older parents have had this type of experience. I think it's very important to remember that these concerns should be discussed in the most caring way possible. Sometimes it can be very annoying to deal with repetitiveness and forgetfulness. If your parent is in denial of difficulty, it's usually not helpful to try to convince him with examples or logical reasoning and, of course, it's never a good idea to argue. I think it's important to let your parent know that your main concern is his or her safety and comfort and that you're there to help and support them in any way needed. Undergoing a neuropsychological exam can also be presented as a way to seek reassurance and you can tell your mother or your father, “Let's just go get the testing and then we won't have to worry about it anymore.” So, even though denial can be a common obstacle to getting your loved one in for the exam, most patients can usually be convinced to go along with it. Sometimes they agree just as a way to prove that they are right.

Melanie:  In just the last few minutes, Dr. Risse, please give us your best advice for those loved ones, people that we love that are getting older, starting to exhibit some of the normal signs of aging, what we should be watching out for? What you really want them to know?

Dr. Risse:  I think the most important thing to remember with aging is to live a healthy lifestyle. None of us know what's coming down the road in two years or five years and we can't predict and latch on to every possible symptom and be worried about it at all times. I think everyone, whether they feel they have symptoms or not, everyone that is aging should be concerned with getting plenty of rest, exercising, eating right, maintaining good social relationships and they shouldn't be afraid to seek assistance from their children and other caregivers when it comes to making important medical decisions or financial decisions. For the children of the elderly, I think sometimes they can help most by trying to anticipate issues before a serious problem arises. This might mean sitting down with your siblings and discussing safety concerns; for example, if the ability to drive or to live independently is in doubt. When a parent insists there is no problem, sometimes it's tempting to let it go for a while because you don't want to get into a conflict. But, again, this is when that independent neuropsychological evaluation might provide the push that is needed to make these necessary changes.

Melanie:  Thank you so much. You're listening to The WELLcast with Allina Health. For more information you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.