Understanding Dementia and the Role of Neuropsych Testing

As a psychologist doing neuropsychological testing with older adults, I often speak to patients and families about dementia. There are many misconceptions about what dementia is and is not, and I find that it’s not always well understood by people outside the medical profession. Hopefully, this information will help clarify what dementia is, how it is different than other conditions, and how dementia testing can help.

WHAT IS DEMENTIA?

Dementia is a general term for loss of cognitive function — memory, thinking, problem-solving, and language — that gets in the way of daily life.  It can be caused by several different types of changes to the brain.  Here are the most common:

• Alzheimer’s disease:  The most common type of dementia, which causes gradual cognitive decline, often over about a decade. 

•  Lewy body dementia: The second most common type of dementia, caused by abnormal deposits in the brain, and with symptoms similar to the cognitive decline that can occur in Parkinson’s disease.

• Vascular dementia: Caused by cardiovascular problems that harm the brain, sometimes gradually over time (for example, high blood pressure), and sometimes suddenly (for example, a stroke). 

• Frontotemporal dementia: This type of dementia impacts the frontal lobes of the brain first (the part behind our foreheads), and can cause personality change, and eventually other cognitive problems.

What Is Not Dementia?

Because dementia is a general term, I often hear it misused or misunderstood. There are various reasons for cognitive changes, and they are not all dementia. Dementia is different than:

Delerium:

A temporary change in cognition that often involves confusion, disorientation, and poor memory. Delirium can happen in response to a medical emergency, a reaction to a medication, a vitamin deficiency, or other immediate medical causes.  Delerium is a medical emergency and must be treated as soon as possible. Fortunately, delirium is usually treatable, and the person can return to normal brain function once the cause is addressed.

Depression: 

This common mental health condition can cause symptoms such as sadness, fatigue, and difficulty concentrating. These symptoms can sometimes look like dementia.  When a person is depressed, they may not pay attention to what is happening around them, which can impact memory. Depression is also treatable with therapy and medication, and once depression is treated, people often see an improvement in their cognition as well.

Hearing loss:

Hearing loss can make it difficult to understand speech, which can lead to problems with memory and communication.  Many times, people assume that because someone has a hearing impairment, they have a cognitive impairment, but of course, they are two totally different conditions.

Vision loss: 

Vision loss can also make it difficult to understand and remember things. Again, just because someone has impaired vision does not mean anything about their cognitive function.

Vitamin B12 deficiency: 

Vitamin B12 is essential for brain health. A deficiency in vitamin B12 can cause symptoms such as fatigue, memory problems, and confusion.

Thyroid problems: 

The thyroid gland produces hormones that help regulate metabolism. Thyroid problems can cause a variety of symptoms, including fatigue, weight gain, and cognitive changes.

Speech problems:

Speech problems such as a stutter or slowed speech after a stroke do not have any bearing on cognitive function, and do not, by themselves, indicate dementia.

Neuropsychological Testing in Dementia

Dementia is not a normal part of aging. Although age is the biggest risk factor for dementia, most older people don’t have dementia.

There’s no cure for dementia, but there are treatments that can help manage symptoms and improve quality of life.  As you can see, there are many potential causes of cognitive change that can look like dementia.  Neurological tests and brain imaging can give some information that helps with a clear diagnosis in cases of cognitive change, but many brain changes are similar across conditions, and not visible on brain imaging until very late into the disease. This is where neuropsychological testing comes in.

Neuropsychological testing is a type of assessment that evaluates a person's cognitive abilities. It is used to diagnose dementia and other brain disorders, as well as to measure the severity of cognitive impairment and track changes over time.

Neuropsychological tests can measure a variety of cognitive abilities, including:

• Memory

• Attention

• Language

• Problem-solving

• Visual-spatial skills

• Executive functions (planning, organizing, and decision-making)

Neuropsychological testing is typically conducted by a psychologist or neuropsychologist; these are doctors who specialize in the assessment and treatment of brain and behavior disorders.

A NEUROPSYCHOLOGICAL ASSESSMENT CAN HELP WITH DIAGNOSING DEMENTIA

Neuropsych testing can be a valuable tool for diagnosing dementia. We can identify patterns of impairment that give information about the cause of brain and behavior changes, including what type of dementia a person may have, or whether there is another explanation for their cognitive change.

For example, people with Alzheimer's disease typically have difficulty with memory and executive functions. People with vascular dementia may have difficulty with attention and processing speed. People with Lewy body dementia may have difficulty with visual-spatial skills and executive functions.

Neuropsychological testing can also help to rule out other medical conditions that can cause cognitive impairment, such as depression, vitamin deficiencies, and thyroid problems.

NEUROPSYCH TESTING CAN HELP WITH MANAGING DEMENTIA

Neuropsych assessment with a psychologist is also helpful for managing dementia. When we know the areas of cognitive decline (for example, memory), we can recommend specific strategies to support the person in need (for example, using reminders and cues in ways that will work best to support that person’s memory).

Neuropsych testing can also be used to track dementia over time.  We can monitor cognitive change, which can inform things like managing money, living independently, and what type of assistance could help someone remain independent for as long as possible.

THE BENEFITS OF DEMENTIA TESTING

Neuropsychological assessment offers a number of benefits for people with dementia and their loved ones:

• Accurate diagnosis: Neuropsychological testing can help to accurately diagnose dementia and rule out other medical conditions. Remember, there are some treatable causes of dementia; an accurate diagnosis could be life-changing!

• Individualized treatment: By identifying the specific cognitive deficits that a person is experiencing, neuropsychological tests can help to guide treatment and support services.

• Tracking progression: Neuropsychological testing can be used track changes over time, and help adjust treatment and support as things change.

• Education and support: Neuropsychologists know a lot about dementia, and can help patients and families understand what is happening, what to expect in the future, and how to plan and support one another.

Begin Dementia Testing in Los Angeles, CA

If you are concerned that you or someone you know may have dementia, it is important to talk to your doctor, and potentially consider neuropsych testing for dementia. Dr. Reger is happy to offer dementia testing and other support from her Los Angeles, CA-based practice. You can schedule an appointment by following these steps:

1. Reach out for a free consultation.

2. Schedule neuropsychological testing with Dr. Reger.

3. Start receiving the support you deserve!

OTHER THERAPY AND TESTING SERVICES OFFERED IN LOS ANGELES, CA

I know that you may need more support in addition to neuropsychological testing. This is why I’m happy to offer several types of assessments and services around Southern California. Other services I offer include psychological evaluations for workers’ comp, preoperative assessments, individual therapy, and therapy for older adults. Visit my blog for more helpful information today!

How Long Is the Psychological Assessment for ADHD in Adults?

I see a lot of adults for neuropsych testing who believe they may have undiagnosed Attention Deficit/Hyperactivity Disorder (ADHD). Because ADHD starts in childhood, undiagnosed and untreated ADHD can have a major impact on all ages. I often get asked about what goes into an assessment for adult ADHD, so here is some info about what to expect, and how long the neuropsych testing process is for suspected ADHD in adults.

It's important to note here that lengthy testing is not always necessary to diagnose ADHD.  A psychologist or psychiatrist who works a lot with ADHD may be able to make the diagnosis just through an interview. But, for many adults (and kids), ADHD is complicated by additional symptoms or problems, and in those cases where things are not straightforward, neuropsych testing is immensely helpful.

ADHD In Adults

In order to understand how long testing takes, we should first briefly cover what adult ADHD is (for a lot more detail, you can read my 3-part series on adult ADHD here). The symptoms of ADHD in adults are different for everyone, but in broad terms, they fall into these categories:

• Inattention. Problems paying attention.

• Hyperactivity. Restlessness and problems being still.

• Impulsivity. Acting or speaking before thinking it through.

In addition to the general symptoms listed above, in adults in particular, ADHD may look like problems with:

• Time management: Adults with ADHD may procrastinate, miss deadlines, or forget meetings.

• Organization: Adults with ADHD may have messy desks or workspaces, and they may lose track of important paperwork or forget parts of tasks.

• Follow-through: Adults with ADHD may start projects but not finish them, or make promises that they don't keep despite the best intentions.

• Emotion regulation: Adults with ADHD may be quick to anger, frustration, or sadness.

• Relationships: Adults with ADHD may be perceived as being unreliable or irresponsible, or have difficulty communicating effectively.

Not everyone will have all of these symptoms, but most people with ADHD can recognize a few in themselves. So, if this reminds you of yourself or someone you know, what should you (or they) expect from psych testing for ADHD?

Neuropsych Assessment of ADHD in Adults

The initial step in the ADHD testing process with a psychologist or neuropsychologist is usually a clinical interview. This interview will cover your:

• Symptoms

• Medical history

• Personal/social history

• Educational history

A comprehensive assessment for ADHD will include more than “just” ADHD tests, because ADHD often comes along with other mental health diagnoses or symptoms, and can also look like several different diagnoses. For example, many people with ADHD also experience depression or anxiety disorders, and these need to be teased apart because the treatments are different. People with Autism Spectrum Disorder are also more likely to have ADHD as well.  So, it’s important to do a comprehensive testing battery to make sure we don’t miss anything that could explain some of the symptoms you are having. Testing only for what we think is going on is very likely to result in biased testing that does not give a complete picture, which can cause more pain and frustration in the long run if the right treatments aren’t offered. In addition to an interview, expect:

• A “collateral” interview.  This means that your psychologist will likely want to speak to someone who knows you and your behavior well, like a partner or family member.

• Neuropsychological tests. These look at function in many cognitive domains, not just attention, because many areas of cognition are impacted by ADHD.

• Rating scales filled out by you and someone else who knows you well.  This is up to you. But, could include a parent, a partner, or a teacher who has observed your behavior. Getting more than one perspective can give valuable information in testing.

So, how long does ADHD testing take?

The amount of time it takes to complete all of the testing for adult ADHD will vary a bit depending on the type of testing that is done and your needs.  (For example, if you also suspect you may have a reading disorder like dyslexia, or an emotional concern, like anxiety, that will require more and different tests). It’s important to allow enough time for the testing process so that you can get an accurate diagnosis and receive the appropriate treatment. In general, expect a testing day to take between 4 – 8 hours.  

People are often surprised that testing takes so long. But one day of testing is a small investment of time in order to get a thorough, accurate diagnosis, and good information for what treatments will help you. Especially for those who have been living with undiagnosed and untreated ADHD; having clear answers and a path forward is often life-changing. 

The most common reaction I get from testing patients after they get their results, including diagnoses and personalized recommendations, is relief, followed by gratitude. Testing feedback can be very emotional. Finally having answers and increased self-understanding is often the first step to healing from years (or a lifetime) of shame and self-blame related to undiagnosed ADHD.

Begin Psychological Testing for ADHD in Adults in Los Angeles, CA

If you are concerned that you may have adult ADHD, feel free to reach out for a consultation to see if neuropsych testing can help. Dr. Reger would be happy to offer support with addressing the symptoms of ADHD from my Los Angeles, CA-based practice. Start testing by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for your capacity assessment

3. Start receiving the support your loved one deserves

OTHER COUNSELING SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments in addition to the ADHD assessment. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations.

Warning Signs of Workplace Stress: What Warrants a Workers’ Comp Stress Claim in California?

The California Division of Workers’ Compensation has specific requirements for what constitutes a workers’ comp claim related to mental health problems. The state requires medical evidence of “injury” to a worker’s mental health (for example, symptoms or a diagnosis of a mental health disorder verified by a psychologist), as well as evidence to support that the injury was caused by events that happened at work, which can be gathered through interviews, depositions, work records, or medical records.

As a psychologist and Qualified Medical Evaluator (QME) in Los Angeles and Orange County, Dr. Reger often assesses workers with mental health stress claims.  This is not legal advice, but from a mental health perspective, here are a few warning signs that stress is becoming unmanageable. If you notice these symptoms after a stressful event or series of events at work, and you are having difficulty recovering, it might be appropriate for you to file a stress claim.

Physical Symptoms of Occupational Stress

Because our minds and bodies are connected, stress can have a major impact on physical health.  It can affect every body system and can cause:

• Headaches

• Muscle tension

• Gastrointestinal/stomach problems

• Chest pain

• Fatigue

• Poor sleep

Emotional Stress Symptoms Related to Workplace Stress

Workplace stressors, such as a traumatic event at work, or sometimes lower severity, but chronic, stress can also cause emotional symptoms.  For example:

• Anxiety and worry

• Irritability

• Anger or a short fuse

• Sadness

• Hopelessness

• Difficulty concentrating

Stress-Related Behavior and Performance Changes

When workers experience chronic stress at work, it can cause problems with work responsibilities, which may seem obvious, but it can also cause other unhealthy changes in behavior.

• Impact on appetite

• Increased use of alcohol or other substances

• Lower productivity at work

• More frequent errors in work

• Difficulty meeting deadlines

Possible Relationship Impacts of Stress

It may seem obvious that chronic stress at work would impact professional relationships.  In fact, conflict in an important work relationship, like with a supervisor, can sometimes be the reason an employee files a workers’ comp stress claim in the first place. But stress can impact relationships across a person’s life, potentially leading to:

• Conflict or withdrawal from co-workers

• Problems interacting with supervisors

• Irritability or withdrawal from partner and other family members

• Social isolation or withdrawal from friends

What You Can Do if You Are Experiencing Significant Workplace Stress

If you have experienced mental health symptoms related to something that occurred at work, you can:

• Seek mental health support.  Many workplaces have an Employee Assistance Program (EAP) as a benefit, and you can get a few covered sessions of supportive psychotherapy through that program.  You can also seek therapy through your insurance, or private pay.

• Inform your supervisor (or if that person is not safe for you, their supervisor or HR).  Often, a supervisor or HR staff at work can help you with the steps of filing an initial workers’ comp stress claim, if you decide to do that.

• Decide whether you want to file a workers’ comp claim for psychological injury. 

• Consult with a workers’ compensation applicant attorney if you want legal advice.

Where a Psychological Qme Evaluation Comes Into a Stress Claim

If you have psychological symptoms that interfere with your life after a stressful workplace event (or series of events), and you decide to file a workers’ comp claim, it’s likely you will need to have a psychological evaluation with a psychologist, like Dr. Reger, who is available as a QME or AME (Agreed Medical Evaluator). This evaluation is designed to be neutral - not biased for or against either side of the claim -  and based on medical evidence. It will involve:

• An interview with a psychologist about yourself and what happened at work.

• Psychological testing, either on a computer or on paper, to evaluate symptoms.

• The psychologist’s review of medical records provided by the attorneys involved.  These could be related to an incident that happened at work, a visit to occupational health where you reported stress or other symptoms related to work, or even your regular medical records prior to the workplace stress.

• A report that will go to the attorneys (if there are attorneys for both the worker and the company) and the Workers’ Comp judge evaluating the case. The report will document the results of the evaluation and the psychologist will provide an opinion about any mental health diagnosis or injury, what factor or factors caused that injury, and any recommended treatments (like psychotherapy).

Start Your Claim for Workers Comp Stress in Los Angeles, CA

Dr. Reger can offer QME reports in Los Angeles, CA, and other services to support you at and beyond the workplace. As a therapist, I would be happy to support you from my LA-based practice. You can start receiving the support you deserve by following these steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for your QME psychological evaluation

3. Get answers that you need to continue with your work comp claim

OTHER MENTAL HEALTH SERVICES IN LOS ANGELES, CA

There are multiple neuropsychological and psychological assessments that you can receive from Dr. Reger. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, she also provides individual therapy, counseling for older adults, and provides mental health consultations and presentations.

The Benefits of Therapy for Older Adults

Therapy is a general term for a variety of interventions that can help people improve their mental, emotional, and behavioral health. There are several types of mental health professionals who provide psychotherapy, including psychologists (who have doctorate degrees), and masters-level providers like Marriage and Family Therapists (MFTs) or Licensed Clinical Social Workers (LCSWs). Psychotherapy can be beneficial for people of all ages, including older adults. Therapy can be a valuable resource for older adults who are facing challenges in their lives, or who want to explore patterns, deal with emotions, or improve relationships.

Common Reasons Older Adults Seek Therapy

Older adults face a few unique challenges that can lead them to consider therapy.  Some of these include:

• Coping with physical and mental health changes. As we age, our bodies and minds change in many ways. These changes can sometimes lead to problems, such as chronic pain, depression, anxiety, and dementia. Therapy can help older adults cope with these changes and improve their quality of life.

• Dealing with life transitions. Older adults often face a number of major life transitions, such as retirement, the death of a spouse, downsizing from a larger home, becoming a caregiver to a partner, financial stress, or moving to a care facility. These transitions can be difficult to adjust to, and therapy can help older adults cope with the emotional and practical challenges of these changes.

• Improving relationships. As we age, our relationships with our family, friends, and loved ones can change. Therapy can help older adults improve their communication skills, resolve conflict, and build stronger relationships.

• Promoting self-care. As we age, it's important to take care of our physical and mental health. Therapy can help older adults develop healthy coping strategies, identify needs, and make changes to improve overall well-being.

WHAT YOU CAN GAIN FROM PSYCHOTHERAPY

There can be a wide array of helpful things that result from therapy with the right therapist.  Psychotherapy can help older adults:

• Reduce stress and anxiety

• Improve sleep quality

• Increase self-esteem

• Enhance cognitive function

• Build social support

• Find meaning and purpose in life

If you are an older adult who is struggling with any of the issues mentioned above, therapy may be a helpful option for you. There are many different types of therapy available, and many mental health providers, so you can find the person and approach that is right for you. Therapy can be a valuable tool for exploring behavior patterns, processing emotions, and navigating changes with support from a psychologist along the way.

TIPS FOR OLDER ADULTS CONSIDERING PSYCHOTHERAPY

If you are an older adult who is considering therapy, there are a few things you should keep in mind. 

• First, it's important to find a psychologist or other mental health provider who is experienced in working with older adults. Just like not all psychologists specialize in working with kids, not everyone is well-versed in aging or the unique challenges that older adults may face.  A geropsychologist, like Dr. Reger, is someone with specialty training in aging and age-related concerns.

• You should feel comfortable with your therapist and be able to talk to them openly and honestly.  There is nothing more important than fit when it comes to how successful therapy is, so don’t be afraid to take advantage of a free brief consultation with a potential therapist, to get a feel for the match.

• Finally, try to be patient with the process of therapy. It takes time to see results because change is difficult. Often in therapy, we are exploring and changing patterns we’ve been in for decades, and that can’t happen overnight.  Therapy can be painful, joyful, funny, frustrating, and bring up many emotions along the way, so try to embrace the process as you go!

Begin Counseling for Older Adults in Los Angeles, CA

If you are ready to receive the support you deserve, I would be happy to offer support. As a Los Angeles Psychologist, I would be honored to help provide the insight to help you better address the concerns affecting you most. You can learn more about what you can expect from counseling for older adults with Dr. Reger by doing the following:

1. Reach out for a free consultation.

2. Schedule your counseling appointment with Dr. Reger.

3. Start receiving the support you deserve!

Other Therapy and Testing Services Offered in Los Angeles, CA

I understand you may need more support in addition to counseling for older adults. This is why I’m happy to offer several types of assessments and services around Southern California. I also offer psychological evaluations for workers’ comp, preoperative assessments, individual therapy and neuropsychological testing. Visit my blog for more helpful information today!