Early Signs of Dementia: What a Neuropsychologist Wants Families to Know

Transcript of Interview: “Early Signs of Dementia: What a Neuropsychologist Wants Families to Know“

**Kim Barnes:** When you first start seeing some concerns about your parent maybe not remembering as well, you don’t always know exactly what to do and what does it mean. Today, I’m joined by Dr. Alexandra Clark. She’s a neuropsychologist at the University of Texas. Thanks so much for being with us and chatting with us today.

when you start seeing these worries, what are the signs that we’re looking for that there might be some dementia involved?

**Dr. Alexandra Clark:** Oh, yeah. So, early things that present oftentimes are people not remembering recent events. Okay? So oftentimes there’s like a preservation of remote things that have happened from their childhood, but recent things.

So forgetting details of conversations that they’ve had, repeating themself, not remembering if they completed a task already or not. Those are certainly warning signs. Okay? And then also, word-finding difficulties. Can’t quite find the word that they want to use in a sentence. sometimes mispronouncing words that they use- all the time. Those are key factors.

**Kim Barnes:** I know in my case with my mom, one of the things I really noticed was processing, of noticing that the checkbook that she’d always been very meticulously about keeping, there was just some irregularities that I started noticing that I thought, something’s not exactly right.”

**Dr. Alexandra Clark:** Okay. Yeah. Act- actually, cognitive impairment or cognitive change, subtle cognitive decline even, can cause changes in our instrumental activities of daily living, and these are really complex tasks like financial planning and management- figuring out how to put your pill box together, figuring out how to, ta- make medical appointments, things like that.

finances are oftentimes the most common one that pops up. That and driving, getting lost in familiar places- or passing your exit on the highway. anything like that, you wanna talk with someone and make sure that you’re monitoring them over time. It’s okay if there’s an occasional lapse, okay?

Those happen to us. And it’s okay if you kind of occasionally forget where you need to be, right? Yeah. But if this is happening consistently- more frequently a couple of times throughout the week, that’s a sign of a major problem.

**Kim Barnes:** Can you also be noticing, too, just how they’re carrying their, themselves as far as is the house not as clean?

Are they not… Have they always been well-dressed, and now they’re not, like having the hygiene?

**Dr. Alexandra Clark:** yeah. So, forgetting to eat. Not remembering, to cook food- and not remembering recipes that they’ve commonly always, made. That certainly is another indicator. Yeah. and then yeah, personality changes is a big one.

So not just kind of what’s happening in the house, but you’re noticing that they’re less interested- in engaging in conversation, less interested in doing things that they love to do- Yeah … and aren’t deriving as much pleasure from being around people, and that was something they always looked forward to- in being around other family members. Big sign that you wanna look out for.

**Kim Barnes:** When you start seeing these signs, what do you do?

**Dr. Alexandra Clark:** Yeah. So you need to schedule an appointment with a primary care physician. This is a doctor that you see on an annual basis, and you need to start logging any concerns that you have.

Things that you’re noticing. You wanna bring that to the primary care doctor, and they might refer you over to a neurologist or a neuropsychologist. We’re all health professionals that work together, and we have different areas of expertise. A neurologist is really good at understanding, is this dementia?

is there some type of neurologic problem going on? Is it psychiatric? and they might do a brief cognitive screen when you come see them, and they’ll also order some tests. We now have blood-based biomarker tests for Alzheimer’s disease. These can kinda give us an indication of, oh- is there something potentially to worry about?

Is this a pathologic disease process? And then a neuropsychologist will do really comprehensive testing. There’s some kind of changes that happen with aging that are normal, but there’s a threshold to that, okay? They can get more severe. and, the neuropsychologist helps distinguish between what is normal age-related cognitive change- and what also might be problematic. And we really work in tandem with the primary care physician and the neurologist. We’re all really trying to figure out, is this reversible? Are there things that are causing cognitive change that, are things we can intervene on? Like, maybe there’s just low vitamin D levels.

That’s a really common thing that happens- in older adults. they’ll check your, hormone levels as well. Those can also cause some cognitive changes. Check for mental health. Depression, anxiety- also can impact cognition. and then we’ll do that comprehensive assessment that consists- of pen and paper task, computerized task, and it’s usually a couple hours long.

It gives a really good snapshot of your cognitive abilities and thinking skills, and is a lot better than a screener that you might get in a primary care clinic.

**Kim Barnes:** So but a lot of times you’ll start with that s- basic screening in the primary care doctor’s office.

**Dr. Alexandra Clark:** Yeah. So sometimes you’ll start with that- and then they’ll say, “Hey, we’re noticing just based on this screener- we might need a more comprehensive assessment.” Or, they might order an MRI and say, “Hey, we’re noticing some, volumetric changes in your brain. We think some, we think more comprehensive testing will help us- figure out are these brain changes correlating with any- cognitive or behavioral changes?”

**Kim Barnes:** How do you have that conversation with your parent that you really feel like it’s important that we have these tests, and they may think that everything is fine, and so they don’t know why that would be necessary?

**Dr. Alexandra Clark:** Oh, yeah.

**Kim Barnes:** Or they may not want to admit that they’re having some concerns.

**Dr. Alexandra Clark:** Yes, absolutely. I think there’s a lot of hesitancy sometimes to go see a neuropsychologist or anyone with psych in the name. Yeah. Absolutely. Yeah. and, people are afraid of oftentimes getting a diagnosis of cognitive impairment.

I always like to tell people, “Hey, think of this as like a mammogram. At 40, we recommend women go get a mammogram- and it’s just as a check.” At 65, we recommend that you go get comprehensive cognitive testing, and it’s good for a check of how you’re thinking. Okay? It’s a baseline cognitive testing.

We always want a good baseline on you- ’cause if there’s any change moving forward, we can do a better job of detecting it. The other thing to tell them is early detection is key because we can prevent it from getting worse. We have new therapeutics available to us, that are disease-modifying agents that cause, that slow the progression of Alzheimer’s- disease. And a lot of the medications that we have that are even symptomatic treatments, excuse me, those are really great early. Okay? The earlier the intervention, the better. We can preserve your functioning, and it’s also good to know is there something going on, okay? if there’s something going on, we can really, intervene earlier and it’ll be better.

**Kim Barnes:** Just more options for treatment. Yeah. Because at some point, if you wait too long, there’s really not much you can do, right?

**Dr. Alexandra Clark:** It’s hard, and the treatments are much less effective when you get to the kinda more moderate to severe stage- of dementia. we want you to preserve your independence and functioning for as long as possible to have good high-quality years of life, and that usually it corresponds to you- having as, intact cognition and as much preservation of your cognitive functions as possible. So I always like to tell people, “Hey, everyone at the age of 65 should get this. Medicare covers this, and a lot of health insurance cover this for a reason.” It’s a good, pr- preliminary test.

Yeah. And if you’re noticing things change over time, it helps us detect things earlier so that we can figure out, all right, maybe now is the time to start an intervention. Also, just going to- Yeah … a neuropsychologist doesn’t necessarily mean that they’re gonna find cognitive impairment, okay? Right.

Oftentimes they’re gonna say, you’re doing great,” and I always think it’s nice to know if you’re doing great as well, right? All, we wanna know, okay, I’ve got nothing to worry about. Right. I’m doing what I need to be doing. and I’m just gonna keep doing that, and- Yeah … and, that’s good as well.

**Kim Barnes:** Yeah.

**Dr. Alexandra Clark:** Right?

**Kim Barnes:** Rea- It can be a reassurance.

**Dr. Alexandra Clark:** Absolutely.

**Kim Barnes:** Right. I also think that we hear a lot from people who have parents with dementia that then their big … And they’re seeing their decline, that the biggest fear is, “Okay, what do I do? I d- I don’t wanna be in that situation too.” So what can we do, especially if we’re watching a parent with, a, loved one with dementia and we think, “What can I do to make sure- or hope better my odds that I’m not gonna get it.

**Dr. Alexandra Clark:** Yeah. So we’ve actually learned that there’s, up to 45% of dementia risk can actually be modifiable or prevented. and that’s things really like taking care of your vascular health. We wanna prevent the development of diabetes, hypertension, high cholesterol. detecting those things and treating them immediately are really important, and these are things that just kind of happen with age, right?

In midlife, a lot of these vascular health conditions present, and if we can get on top of them and keep them from getting worse over time, then, we can prevent dementia risk or reduce your risk for dementia. Other things to think about are physical activity. You gotta stay active.

All right? Physically, we want you to be, active aerobically, moving your heart, and as well as strength training, okay? As well as stretching. It’s a whole body thing. We realize that aerobics isn’t just, the only important thing. strength training is key, okay? reading, staying mentally engaged, very important.

You don’t have to go learn a new language, although that does keep you mentally challenged. But reading is really important. It keeps you… You’ve gotta follow plot lines. You’ve gotta link characters together. And then talking about what you’re reading with other people inherently contributes to socializing, which is another big thing.

Okay? Staying socially active and connected to people, not being isolated is really important. And then finally, your mental health. Stress and, like, we’re living through a really difficult time. We wanna make sure that you’re not depressed. We consider that to be a modifiable risk factor- for dive- dementia, as well as, chronic stress, anxiety, and, like, you’re feeling tense, highly irritable.

If you’re feeling those symptoms, oftentimes we can offer medication. And there’s also, therapy that is highly effective. and again, these are modifiable factors. and meaning that we can do something about them. Yeah. And you should be looking out for them- Yeah … and intervening on them early.

**Kim Barnes:** Yeah. What are the risk factors that we can’t control?

**Dr. Alexandra Clark:** Yeah. So age is a big one. Okay? As we get older, you’re at increased risk for dementia. it doesn’t mean that as you get older you’re guaranteed to develop dementia- Sure … but there is a risk associated with aging. Another one is genetics. We have some genetic variants, deterministic, and risk genes.

So those genes are, like, PSEN1, PSEN2, APP, and APOE4. That’s one

that you can get when you do that 23andMe testing. The deterministic genes basically say if you’ve got these genes, you’re destined to develop dementia. But the risk genes, which are actually way more common, if you g- kinda note that you’ve got one of these, you’re at increased risk, but again, not guaranteed to develop dementia.

Okay? And then finally, family history. If you’ve got a strong family history of dementia, multiple family members have been impacted, your grandparents, your sibling, your parents, that is, even more of a reason to get some baseline testing at the age of 65- so that if we, we know you’re at risk, if we detect any type of cognitive change, again, we can intervene earlier.

**Kim Barnes:** But I think the key to that is just knowing that the more you know, the more you can try to do to help prevent or prolong.

**Dr. Alexandra Clark:** Absolutely. information is key, and I don’t want people to be scared of it. Sometimes they’re, afraid to go to the doctor ’cause they don’t wanna hear bad news, but information is power, okay?

We know that if there’s something going on and we can detect it- we can immediately get ahead of it- as opposed to dealing with it after the fact. treatments are helpful, but they don’t really, they’re not as effective as prevention, okay? So if we know there are some mild changes that we can prevent that from getting worse over time- we don’t wanna just be treating once you’ve already developed the disease. Right.

**Kim Barnes:** So that’s why this all needs to start early. The earlier, the better.

**Dr. Alexandra Clark:** Early intervention, diagnosis, identification, those are always things that are coming up in our conversations with people- at a part of any psychoeducational material we’re giving people.

and that’s a reason not to be afraid to go to the doctor, not be afraid to have these conversations with the doctor, and to make notes and just keep track of things with your loved one- as well as if you’re noticing things, write them down. Start those conversations early.

**Kim Barnes:** And I’m thinkin’ what I’m hearing you say, too, is start those conversations with our parents as well as the things that we’re telling ourselves as far as watching, getting the treatment, or just getting, just watching getting those tests done.

**Dr. Alexandra Clark:** Yes. Right. Yes. Get the tests done. Start the conversations with your parents about what are their wishes, are they noticing any changes. And then you wanna have those conversations with your kids, too- moving forward, right? “Oh, if I’m starting to experience cognitive decline or cognitive changes- I want you to have a conversation with me about it so that I know that I need to go to the doctor and get it checked out.”

**Kim Barnes:** Yeah. I have a friend that actually wrote herself a letter and gave it to one of her daughters and said, “If I start having memory problems, please show this to me, that I’ve given you permission to do these things.”

To have this conversation. Yeah, exactly. And what do you do with a parent who doesn’t realize they have a problem? Literally doesn’t think that they’ve- Like just the other day my mom said, “Do you think I have- Nothing’s wrong … do you think I have a memory problem? I don’t think I have a memory problem.”

**Dr. Alexandra Clark:** Yeah. That’s actually, can be a part of the disease. It’s called anosognosia, which is a lack of insight or awareness into your cognitive problems. the biggest place to start with them is say, “I think we need to go to the doctor,” and to use, leverage the conversations and medical appointments with the doctor to help give them additional insight.

Okay. I would also say this is where writing things down are really helpful. you don’t wanna attack them or really make them feel uncomfortable, but sometimes when you point out to them, “You got lost and I was worried, okay?” Or, “I’m a little worried about you watching the, our grandkid alone.”

that can kind of be more salient to them and, activate those emotions, and also motivate them to go to the doctor and get a more thorough- evaluation.

**Kim Barnes:** Okay. ‘Cause I think that we’ve gotten to the point where that, that having those conversations don’t, they don’t help because she doesn’t remember.

**Dr. Alexandra Clark:** Yeah.

**Kim Barnes:** And so there, that’s the part that where I always say that dementia just doesn’t make sense. It just is, it just doesn’t make sense. No.

**Dr. Alexandra Clark:** I can’t think of a

**Kim Barnes:** better way to describe

**Dr. Alexandra Clark:** it. Yeah. Yeah.

**Kim Barnes:** Yeah.

**Dr. Alexandra Clark:** Yeah, it’s hard. I think kinda knowing that, like this is a key feature of it is they don’t remember- Right

and they’re especially not gonna remember these conversations. Right. It, it’s, you gotta know it and it’s helpful. Right. And we can’t kinda get in a battle with them about things, because it can make them feel really defensive and isolated. But yeah, it’s really incredibly difficult as a caregiver to navigate, right?

Yeah. When they don’t have the insight, and they’re asking the same questions over and over again. there’s some really great tools or tips that the Alzheimer’s Association offers about how to talk with loved ones- about these, issues that they’re- experiencing. it’s, you can go to the alz.org- Yeah

and look at patient resources, and it’ll give you some prompts and, to ask people. And, there’s a workbook even that you can fill out. And these are fantastic resources. You wanna start doing them earlier. And they’ll teach you skills also to leverage when you’re at that moderate to severe part of the disease process as well.

**Kim Barnes:** Right, yes. We’ve learned about therapeutic fibbing and all of those different kinds of techniques that you- Confabulation,

**Dr. Alexandra Clark:** yeah.

**Kim Barnes:** Confabulation. Yep. Yeah. Awesome. Yeah. Well, thank you so much for sharing your expertise with us today. The, it is a topic that we could go on for a long time, but- Oh, yeah … but you’ve given us a lot of great information to take today.

So if you have any other ideas that you’d like us to cover in Parenting Aging Parents, please let us know.

*This transcript is auto-generated. Please excuse any typos or mistakes.