Detecting Individual Differences in Changes in Memory Functioning
Dr. Len LecciProfessor of PsychologyUniversity of North Carolina Wilmington
Director of Clinical ServicesMemory Assessment & Research Services0
Trends in MCI and AlzheimersUnvergatz et al, 2001
The incidence of dementiaLess than half of the population (45%) aged 84 and older is cognitively normal - NIH, 2001
Prevalence Rates Age Alzheimers Disease All Dementias60-64 0.3% 1%65-690.9% 2%70-742.0% 4%75-794.1% 8%80-8411.7% 16%85 & older22.8% 30-45%
Rates for each person would also vary depending upon your risk factors, genetic predisposition, etc, all of which can double, triple, or quadruple your risk. Prevalence Rates based on the most recent Report to the Surgeon General, 19990
Degenerative Pattern of Neurons0
Rate of memory decline increases 5.1 years before dementia diagnosis (Hall et al, 2000)0The Course of Dementia
New and Emerging TreatmentsNew MedicationsCholinergic Enhancers (e.g., Aricept, Reminyl/Razadyne, Exelon, Cognex)
Neuroprotectors/cell death blocker (Namenda)
Anti-beta amyloid drugs (Phase III trials)
Early Detection and Treatment of Memory Loss Greatly Improves Quality of Life
Benefits of early detection/interventionAt current rates of nursing home admissions, a one-month delay would save more than $1 billion annually in Alzheimer care costs alone in the U.S.Treatments that delay onset by five years would reduce the number of individuals with Alzheimers disease by nearly 50% after 50 years.
Alzheimers Association and the National Institute on Aging
Do I have a memory problem?
Normal forgetting or early signs of a serious problem?
Subjective self-assessment of memory functioning based on anecdotal experiences (long vs. short term memory)
Research: Individuals with cognitive impairments (memory deficits) do not typically realize that they have these problemsself-reported assessments are ineffective0
Detecting dementia during routine physical exams< 3% of those evidencing the early stages of dementia are detected during routine physical exams
< 25% of those evidencing moderate to severe dementia are detected during routine physical examsReport to the Surgeon General, 1999
Time constraintsLimited specialized training in memory evaluationsInaccurate selfreport of patients Limited use of standardized measuresInfluenced by verbal skills of the patientOne dimensional view of memory0
Multi-Factorial View of Memory0
Most effective method for memory screeningUsing comprehensive, standardized, and validated tests to screen for memory impairment
Thorough assessment of memory: Assessing visual and auditory memory, immediate and delayed memory, memory capacity, memory learning curves, etc.Approximately 45-60 minutes to administer (+ scoring)Administered by a trained psychologistAllows for comparisons with people of the same age Assess other cognitive areas as well*Assess more than once
Case Study 1: Mrs. H.3.02.01.00.0-.1.0-2.0-3.0Time 2 assessmentTime 1 assessmentNormal coursePerformanceTime 3assessmentDenotes time of first diagnosis0
Who should be evaluated for memory problems?Anyone 55 or older: To establish a record of functioning.
Risk Factors include: 1) Family history of dementia (48% if parent with early onset)
2) Type II diabetes, high BP, high cholesterol
3) Known or suspected CNS dysfunction (stroke, tumor, etc.)
4) If undergoing treatment (medication, surgery) that may effect a cognitive or behavioral change
5) Those already diagnosed with dementia to optimize treatment outcomes (i.e., more aggressive treatment). 0
MARS is located in the UNCW Executive Development Center in the Northeast Regional Library building at Landfall Center910.962.7898
Educational opportunitiesUndergraduate students completing advanced practicum placementsPSY 451 (3 credits per semester)Graduate students in psychology completing practicum and internship (hours towards licensure as LPAs)Opportunities for extensive testing experience and weekly grand round reviewsExposure to repeat testing with a sample of normal aging and progressive dementia casesGraduate students from the school of businessInterns and class projectsPost doctoral trainingJob opportunities for UNCW graduates
Memory disorders appear to be far more prevalent than was previously thought. The rate of decline is progressive
Aricept etc. Enhancing efficiency of spared brain cellsMemintine: Prevent disease from destroying brain cellsAsprin, Lipitor, - decrease risk of developing dementiaToxin removal: clinical trialsgalantamines trade name changes from Reminyl to Razadyne How many people in here have ever wondered if they have a problem with their memory? How many of you forgot the question? What made you worry or wonder about your memory? Something as simple as misplacing your keys? Although this is a valid and important question, how individuals go about answering this question is typically problematic and leads to inaccurate conclusions. Specifically, we tend to use a subjective evaluation of our memory.
As Len stated, we will be using the best diagnostic test available. Nevertheless, the current test can be greatly improved. The current clinical assessment measures four general features of memory. Cognitive psychologists have been studying memory for well over a century. We study it from a functional point of view. That is, what are the different features of memory, how do they interconnect, and what factors affect their performance. One may notice that this set of features is much more detailed than that of the clinical assessment.
We will create a diagnostic battery cognitive tests that assess the functioning of many features of memory. Mars is unique, in that is provides a longitudinal, elderly client base. Some clients will be start testing pre-dementia and develop dementia over the course of years, some clients will never develop dementia, and other clients will be in various stages of dementia. We will ask a subset of our clients to volunteer to participate in this research program. We will our diagnostic battery for free over the course of several years. We expect that some of the tests in the battery will be very sensitive to early dementia than others. This research will lead us to develop a test that is quite sensitive to the early stages of dementia. We will use this test in our assessments and market this test to the professional community.
Standardized assessments means that the evaluation is carried out in the same way for everyone; using the same procedures, the same scoring and identical interpretations. Presently, such initial evaluations tend to rely on highly idiosyncratic ways which are not accurate (e.g., some of the questions we mentioned earlier, the degree to which you worry about it, or even a few questions from your physician during a routine physical). These approaches will often miss real memory problems.