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Memory Disorder/Dementia

Memory problems are experienced as one ages. However, memory difficulty does not always indicate a form of dementia. Actually, memory difficulty is experienced as a normal part of aging. It can also be a sign of Mild Cognitive Impairment (MCI), which is not a form of dementia. Memory problems can also be due to depression, medication side effects, alcohol use, thyroid disease and B12 deficiency.  At other times, memory impairment is actually due to dementia which can be caused by Alzheimer's disease, vascular dementia, dementia with Lewy bodies, Frontotemporal dementia, and mixed dementia; or it can be a result of other disorders linked to dementia such as Parkinson's disease, Huntington's disease, ​Creutzfeldt-Jakob disease, and traumatic brain injury (TBI). It is important to obtain a Neuropsychological Examination by a Board-certified Neuropsychologist to determine if an individual has normal aging, MCI, or dementia.

Memory impairment may or may not indicate Alzheimer's disease

While Alzheimer's disease is the most common form of dementia, there are numerous other types of dementia which can be caused by vascular disease, traumatic-brain injury (TBI), as well as over 100 diseases and conditions. We think of Alzheimer's disease and dementia as being a condition of the elderly. While dementia is less common in individuals who are in their forties and fifties, it does occur. When dementia develops prior to age 65, it is known as pre-senile dementia. Normal age-related memory loss should not be a cause of concern in most people. However, memory changes or other cognitive complaints that interfere with a person’s daily function warrant further evaluation, regardless of age.

With recent media attention on Bruce Willis and Wendy Williams both having Frontal Temporal Dementia, the public has become much more aware of this condition. It is noted that Frontal Temporal Dementia often occurs at an earlier age than Alzheimer's disease, and it is frequently missed due to its early onset with the clinical presentation being much different than that found in Alzheimer's. Neuropsychological evaluation is often the preferred clinical method to diagnose Frontal Temporal Dementia.

Diagnosis:

Neuropsychological Evaluation is the best form of determining if memory problems are due to Alzheimer's disease, Mild Cognitive Impairment (MCI), or just normal aging. Recent medical research has found that blood markers (P-tau217, Amyloid-B, etc.) can assist in the diagnosis of Alzheimer's disease. As noted in the journal, Lancet Neurology, diagnosis of dementia is best made by clinical assessment, not the use of biomarkers. 

 

Neuroimaging, using MRI (brain volume) and PET (brain activity) scans, can assist in diagnosing Alzheimer's disease. However, these methods do not actually measure the level of cognitive impairment or the specific cognitive domain that is impaired. That is why Neuropsychological Evaluation, not MRI or blood analysis, is specifically utilized for determining whether retired NFL players have dementia for example.

While neurologists, psychiatrists, and family practitioners often perform screening tests which can assess people with dementia and identify individuals who may need further evaluation, these cognitive screening tests are not able to determine if the memory impairment is due to normal aging, MCI, or dementia. Neuropsychological testing is required to determine the cause of the memory impairment, and if due to dementia, then what type and how severe.

Treatment:

 

Some forms of dementia can be reversed with treatment. Examples include: Vitamin B12 Deficiency and Cirrhosis (Hepatic Encephalopathy). However, most forms of dementia cannot be cured, although there are ways to help manage the symptoms. Getting an early diagnosis of dementia is important for a person to receive early treatment and therapies if indicated, and the support required to help them plan for the future. 

Neuropsychological Evaluations

Neuropsychological Evaluation is the best way to determine if

memory impairment is due to Alzheimer's disease or another medical condition

Neuropsychological Evaluations examine how a brain is functioning. It is the best window into looking at how the brain is actually working. These evaluations accurately measure memory, attention/concentration, reasoning, processing, speed, language, and visual-spatial functions. Testing reveals if there is impairment and what the level of impairment is. Test results are interpreted with careful consideration of an individual's medical, educational, and work history.

Neuropsychological Evaluations determine not only if there is cognitive impairment, but most importantly, what is the level of impairment. Test results provide the individual and/or their family members with critical information for decision making. Individuals and their family members frequently have questions about whether the individuals should continue to work, safely drive, or make competent choices in their medical care and finances. A Board-Certified Neuropsychologist can help develop individualized strategies that the patient and caregivers can use to help manage specific deficits. At this time, there is no cure for dementia, but there are treatments that can help manage and improve quality of life. 

 

What to Expect:

 

The entire examination is personally conducted by Dr. Kutner, which contrasts with most Memory Disorder Clinics and Hospitals in which testing is usually completed by doctoral students or technicians. Dr. Kutner believes in providing one-on-one specialized attention by administering all of the Neuropsychological testing himself, as well as score the testing, preparing a full Narrative Report with the results, and provides a follow-up consultation for recommendations.

The neuropsychological evaluation with Dr. Kutner will last approximately 4 hours.

The tests are noninvasive, meaning there are no needles or having to be hooked up to machines.

Dr. Kenneth Kutner

Dr. Kutner is a Board-Certified Neuropsychologist with more than 30 years of performing evaluations for patients with memory impairment. At Weill Cornell Medicine, he was involved in Alzheimer's disease research. Also at Weill Cornell, he was involved with the Memory Disorder Group, where he presented on the role of Neuropsychological Assessment in memory impairment. Dr. Kutner has completed the Alzheimer's Association Training Certification. At Dr. Kutner's offices in Southeast Florida, he examines patients who are concerned about memory impairment, or who have family members who seek determination on whether dementia has developed. 

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