Memory clinic

Many adults complaint about memory difficulties.

Some seriously worry about possible memory loss, or early Alzheimer’s disease.

For clients with subjective memory complaints, the neuropsychological evaluation is the best predictor of the first signs of  Alzheimer’s disease, before the memory difficulties has an impact on functioning.

Moreover, in some cases, adult ADHD, significant anxiety or burn out can mimic the signs of an Alzheimer’s disease. Only a neuropsychological evaluation with a skilled professional could make such differential diagnosis. This is especially in high functioning adults, where the cognitive screening toold (e.g. MoCA) may have limited sensibility.

 

SERVICES IN NEUROPSYCHOLOGY : the ‘typical’ process for an adults over 50         

  • Clinical interview. 2 hours. Arrive early to fill out the consent forms and be prepared to fill out questionnaires after our meeting – I am trying to get to know you as best and quick as I can.
  • Neuropsychological Evaluation. 4 hours. Tests of attention, visual and verbal memory, praxis, language, reasoning, etc.
  • Scoring the results. I look at all the questionnaires, all the tests, all the symptoms you have reported and I try to find patterns, explanations and solutions. Then I prepare either a verbal report, a 2 pages summary for you, a letter for your Physician or a full report – depending on your needs. 1 hour to 4 hours.
  • Feedback session. 1 hour. I give you the diagnosis and some recommendations.
  • NOTE : Discussion about the diagnosis can take longer than 1 hour. It is often very beneficial for the patient to take the time to integrate all this information. If needed, some medication can be prescribed and controlled by your GP. Send your GP a copy of your report. He will follow up with the appropriate pharmaceutical treatment. He is the one who knows best about your physical health.

This usually costs around 1440$ for the complete evaluation with detailed report.

Not sure if you want / need a neuropsychological evaluation?

Initial in-person consultation. A complete neuropsychological assessment is a very thorough process and might not always be warranted. An initial in-person consultation is suggested. This initial consultations is a 2 hours appointment (320$) during which Dr Gagnon will conduct a thorough interview and basic cognitive screening, as necessary. Based on this initial assessment, a neuropsychological assessment will be recommended or not (see above). You may also receive suggestions and recommendations or a brief educational session, depending on the initial findings and clinical impressions.

 


 

NORMAL AGING, DEMENTIA AND “PSEUDO DEMENTIA”

Normal Aging: as we get older, our cognition might change slightly.Beginning about age 25, numerical ability/arithmetic and processing speed starts to slowly declines. In the 40’s, and perhaps as late as 50’s to 60’s, some aspects of memory declines slightly (episodic memory).  However, word knowledge, vocabulary, word reading generally remains stable into late adulthood (70’s+). These changes are usually minor and naturally compensated for by the aging individual.
When changes in cognition are greater than what can be expected for age,

  • Mild Cognitive Impairment (or Minor Neurocognitive disorder, as per DSM-5) can be defined as an ‘abnormal’ decline in cognitive function greater than expected for age.
  • Dementia (or Major Neurocognitive disorder, as per DSM-5) can be defined as a decline in previously acquired cognitive and behavioral abilities which leads to deficits in ability to function

Most importantly, with aging, individuals become more sensitive to the effect of stress, which can limit our ability to fully use our cognitive resources.

Clinicians historically designed this as “Depressive Pseudodementia”: when older people exhibited symptoms consistent with dementia but the cause was actually Depression (mood). Even if the term Pseudodementia is not used as often nowadays, the idea remains. The differential diagnosis between these 2 conditions can be quite complex and the two often overlap. Diagnosis by a skilled neuropsychologist  is often required.

For more info about this topic, read publications by Sonia Lupien, Ph. D., researcher based in Montreal and Scientific Director at the Fernand-Seguin Research Center for more research on the effect of stress on cognition in aging individuals.  http://www.iusmm.ca/research/researchers/researchers/sonia-lupien.html

Detailed neuropsychological evaluation assists differential diagnosis. It might help tease apart the effect of stress VS aging. If there are cognitive deficits, neuropsychological evaluation should help Identify subtypes of MCI, Differential diagnosis of dementias, Allow early detection, Start treatment planning with a physician, Determining care needs (placement), Determining competency/functional capacity.

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