Early Detection of
Cognitive Disorders
Robin J. Heinrichs, Ph.D., LP
Neuropsychologist & Assistant Professor
Director of Neuropsychology Laboratory
What is cognition?
 Thinking
 All the things our brain does to help us do things,
learn things, and verbalize and understand others.
To name a few …
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Learning
Memory
Attention
Speed of processing
Visuospatial abilities
Planning
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Comprehension
Verbal fluency
Solving problems
Switching between
tasks
 Abstract thinking
 Sequencing activities
Does cognition change with age?
 Processing speed … influences …
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Attention
Word-finding
Memory
Cognitive flexibility
 Less efficient at learning new information
 Therefore poorer recall
 30 years and after …
Normal/typical aging
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Not impairment
Noticeable
Annoying
Function fine
When to be concerned?
 Decline is worsening
 Interferes with functioning
 Others around us concerned
 What could this be?
 Dementia
What is dementia?
Dementia is an enduring decline in cognition that interferes
with functioning in everyday living.
American Psychological Association
Dementia is an enduring decline in cognition that interferes
with functioning in everyday living.
American Psychological Association
 Changes are worsening, often gradually over time
 Different types of dementia follow different patterns of
decline
Dementia is an enduring decline in cognition that interferes
with functioning in everyday living.
American Psychological Association
 Some portion of cognitive abilities have declined
 Pattern of decline varies depending on the cause
 Decline is in more than one area of cognition
Dementia is an enduring decline in cognition that interferes
with functioning in everyday living.
American Psychological Association
 The change in cognitive functioning must be severe enough
to make it harder for the individual to carry out activities of
daily living
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Managing finances
Managing medication
Maintaining a calendar and going to appointments on time
Preparing meals
Dementia is a general diagnosis
If decline in cognitive abilities and difficulty functioning are
severe enough = Dementia
 Cognitive decline that is 2 standard deviations below previous
 Decline in more than one cognitive domain
A diagnosis of Dementia does not tell you what is
causing the decline.
 Dementia can be caused by many diseases and
pathologies that have affected the brain.
 Knowing the cause tells us what to expect in the
future.
Early detection benefits
 Allow the individual to plan and make decisions for
themselves before they are unable to do so
 Allow the patient and family to ensure safety and
well-being over time
 Future – hope is that treatments will be found to
intervene early in the disease (pre-clinical)
Types of dementia
 Alzheimer’s disease
 Frontotemporal disease
 Vascular disease
 Parkinson’s disease
 Lewy body
 Other
Alzheimer’s disease (AD)
The best method of early detection of Alzheimer’s
disease and other dementing processes is
Neuropsychological assessment.
 4 years before diagnosis
 Poorer memory for new information than others
same age = Alzheimer’s diagnosis later
Best Predictors of AD – Preclinical Stage
 Naming & fluency
 Verbal memory
 Abstract reasoning
 Gradual decline in memory for new = Best preclinical
predictor
Clinical AD cognitive impairments:
 Learning and memory
 Trouble naming and verbal fluency
 Visuospatial abilities
 Carrying out tasks (apraxia)
 Executive functioning (problem-solving, sequencing,
set-shifting, concept formation, abstract thinking)
 Lack of awareness of impairment (agnosia)
 AD is a disease in which nerve cells in the brain degenerate
and die
 Historically the disease was identified by amyloid plaques
and neurofibrillary tangles in the brain upon autopsy
 Today we think this is late in the disease and these are found
in brains without AD
 Research continues with promise
Temporal lobe
 First notice trouble remembering
things - May repeat the same
questions or stories
 Damage to the temporal lobe of
brain
Frontal lobe
 The frontal lobe experiences
damage next.
 This causes problems with
executive functioning.
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Focusing
Multi-tasking
Problem solving
Staying on track with a task
Switching between tasks
Abstract thinking
Comprehension of complex
information
Course of AD:
 Gradual decline in abilities
 Increasing need for assistance
 First with independent tasks - finances and medication
management
 Then daily tasks like dressing and bathing
 Course of disease varies and can range from six to
fifteen years.
Frontotemporal disease (FTD)
Caused by degeneration and death of nerve cells within
the frontal lobes and the temporal lobes.
 In general caused by loss of neurons and abnormal
amounts or forms of tau proteins in the brain.
 FTD is relatively difficult to diagnose as a decline in
memory is not associated.
 Instead, executive functioning abilities decline.
FTD looks different
Executive functioning changes:
 Focusing without distraction
 Planning and sequencing
 Solving problems
 Comprehending complex information
 Multitasking
 Focus on unimportant details and missing the big picture
Personality changes
 Often looks like a psychiatric disorder
 Of all changes, changes in personality are often the
most upsetting to families
 Failure to inhibit inappropriate behaviors, e.g. loud, rude
comments in front of others that do not bother the
patient
 Inappropriate sexual comments to others
 Flattened reaction to emotional events, e.g. when
spouse is upset they do not react
 OR … more easily irritated or upset, more often tearful
Primary progressive aphasia
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Form of FTD
Trouble coming up with what you want to say.
Difficulty finding the right word.
Pronunciation problems.
Paraphasia; saying words that sound like the one you want.
Trouble reading.
Difficulty writing.
Course of FTD:
 Gradual decline in cognitive and functional abilities
 Gradually increasing need for assistance with tasks
 Because trouble carrying out tasks is primary
difficulty, assistance is often needed earlier in the
disease
 Course varies from several years to ten years.
Vascular dementia
Vascular dementia is caused by cerebrovascular disease
through any insult to the brain by blocked blood flow or a
bleed within the brain.
 Terms used include: stroke, transient ischemic attack (TIA),
hemorrhage, ischemia, embolism, thrombosis, infarct
 These events cause brain cells to die in the affected areas.
 This causes cognitive deficits that coincide with the area of
insult.
 For example, if a blockage or bleed occurs in certain areas of
the left hemisphere, patient will have difficulty speaking or
understanding what is said.
 The bigger the area of insult the more cognitive damage.
 The longer the anoxic insult or the bleed, the greater the
cognitive decline.
Important!
 Cognitive decline in vascular dementia is more sudden than
AD or FTD.
 Insult … then cognitive decline … then some recovery … left
with enduring deficit
 Step-wise decline
 If no more vascular insults occur cognitive abilities will not
decline more.
 BUT … past CV disease makes future CV disease more likely.
Other causes of dementia
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Parkinson’s disease – not all incur cognitive decline
Huntington’s disease
Multiple sclerosis
Lewy body disease
Anoxic insult
Signs to look for
Patient or family mention …
1. Personality change
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More irritable
More laid back
Tearful
Disinhibited
Lack of motivation, interest in things
Lack of awareness of any deficits
2. Difficulty getting along with others
3. Work is harder now
4. Poor review or criticism from boss at work
5. Takes longer to figure things out
6. Patient stopped fixing things around house, quit using
computer, etc.
7. Patient stopped reading or other activities they used to do
8. Financial problems, late bills or trouble with bank
9. Car accidents or tickets; doesn’t like to drive now
10. Repeating themselves or asking others the same
questions; forgetting
Then what?
 Schedule a neuropsychological evaluation
 KUSM Memory and Cognition Clinic
 293-3850
 7829 E. Rockhill, Wichita KS 67206