Neuropsychological Services - memory and aging

Memory and Aging

Welcome to our Memory and Aging assessment and consultation services at Toronto Psychology Centre.

Memory plays a pivotal role in our lives. In a broad sense, it serves as a personal narrative and helps give meaning to our past, present, and future. Memory solidifies our identity and connects us to loved ones and the different communities that are part of our lives. Memory is also practical and integral to our day-to-day functioning such as recalling skills we’ve learned and retrieving details that help us accurately navigate through an array of information.

Until we experience a decline in this vital aspect of our brain functioning, memory is in the background of our experiences and often taken for granted.

Neuropsychological assessment can be helpful in answering many different types of questions in relation to changes in memory and thinking. For example, some individuals want to know if they are experiencing age-normative memory changes or whether their memory decline is more emblematic of a medical or neuropsychological condition (e. g., hypothyroidism, mild cognitive impairment, dementia). Our neuropsychological services can identify specific neuropsychological conditions associated with changes in memory and thinking such as mild cognitive impairment, early onset of Alzheimer’s disease, frontotemporal dementia, Lewy body disease, progressive supranuclear palsy, memory disorders associated with Parkinson’s disease, multiple sclerosis and Huntington’s disease. These assessments can also assist with clarification of memory difficulties associated with a concussion or traumatic brain injury.

Neuropsychological assessment can clarify your specific diagnostic questions, identify psychological interventions, involve collaboration with family and caregivers/professionals about how to best support a person with more significant memory changes, as well as suggest targeted accommodations. Our aim is to help you gain a better understanding of why you are struggling and identify appropriate treatment recommendations and accommodations.

Common reasons for a memory assessment:

  • Concerns about memory and attention problems

  • Confusion with time or place

  • Challenges in planning or solving problems

  • Differentiating between dementia vs. depression

  • Questions about normal aging vs. early dementia

  • Difficulty completing familiar tasks at home, work or leisure

  • Forgetfulness that disrupts daily life (e.g. getting lost, difficulty remembering to take medications)

  • Recent problems with words in speaking or writing or comprehending conversations

  • Trouble understanding spatial relationships or using common objects

  • Withdrawal from work or social activities

Age-normative changes in memory

The brain continuously changes and develops across the lifespan. These shifts in functioning are typically manageable and do not disrupt important areas of life such as occupational and social functioning or activities of daily living needed to live independently. If you are over 50, it is likely that you have experienced some changes in your ability to remember things. Decline in memory functioning is an inevitable part of the aging process.

Memory is not a unitary entity. Some memory functions become weaker with aging, while others remain unchanged or may even improve. For example, there is some decline in episodic memory, which supports our ability to recollect our personal experiences (e. g., the “what, where, and when” of our lives). Prospective memory, remembering to carry out a planned action in the future, also declines with age without the use of environmental cues. On the other hand, semantic memory, our general knowledge about the world, and procedural memory, which reflects learned skills, are relatively preserved or even facilitated with aging. Biological changes in the brain associated with aging, such as shrinkage of neurons or reduced conductivity between neurons, provide one explanation for age-related memory decline.

Neuropsychological testing involves the assessment of many different types of memory. The results of an assessment can help to distinguish between normal age-related changes in your memory or the early warning signs associated with mild cognitive impairment and more serious cognitive impairment such as a dementia.

Mild Cognitive Impairment (MCI)

A sharp decline in short-term memory may be a symptom of mild cognitive impairment (MCI). People with MCI tend to retain critical thinking and reasoning skills but experience a significant short-term memory loss. They may experience trouble remembering the names of people they meet, reciting a telephone number they just learned, or have difficulty with the flow of a conversation. They also may have an increased tendency to misplace things and rely more on notes and a calendar. Importantly, MCI does not significantly interfere with performing everyday tasks and being socially engaged.

There are two categories of mild cognitive impairment. The first type is an amnesic MCI, which refers to problems with memory. This may involve forgetting recent information such as something learned in a conversation or being forgetful and misplacing things. The second type is non-amnestic MCI, which involves a decline in concentration, problems with executive functioning (e. g., planning, multitasking, decision making), language skills (e. g., forgetting words), or problems with visuospatial skills such as navigation (i. e., finding one’s way around).

MCI may be a signal of a more serious condition, as it is typically viewed as a transitional stage between normal memory loss during aging and conditions such as Alzheimer’s disease. However, not all individuals with MCI develop a dementia.

Dementia

The word “dementia” is an umbrella term used to describe a set of symptoms that includes impairment in several cognitive domains, including memory, reasoning, judgment, language, and other thinking skills. It is a broad term covering several different brain conditions that have in common a decline in one’s cognitive abilities. Dementia often begins gradually and worsens over time. Unlike MCI, the cognitive impairment in dementia is severe enough to significantly impact a person’s ability to independently carry out activities in daily life, such as working, hobbies, managing finances, preparing a meal, or taking medications.

According to the Alzheimer Society of Canada, currently over 500,000 Canadians are living with dementia with estimates of approximately 25,000 new cases being added a year. Despite this high number, the majority of adults do not develop Alzheimer’s disease, which is the most common type of dementia. Fewer than one in five under the age of 65 and less than half of those age 85 and older develop Alzheimer’s disease.

Diseases that cause progressive damage to the brain and consequently result in dementia include:

  • Alzheimer’s disease

  • Creutzfeldt-Jakob disease

  • Frontotemporal dementia

  • Huntington’s disease

  • Lewy body dementia

  • Mixed dementia

  • Parkinson’s disease

  • Vascular dementia

Research also indicates a link between your heart and brain functioning. For example, heart disease can increase your risk of having vascular dementia and Alzheimer’s disease. Other types of conditions that cause heart disease and are also associated with a higher risk of developing Alzheimer’s disease include: high blood pressure; high cholesterol; diabetes; poor diet; and a non-active life style.

Many medical problems can cause memory loss or other dementia-like symptoms. Most of these conditions can be treated. Possible causes of reversible memory loss include: brain disease (e.g., brain tumour or infection); chronic alcohol abuse; concussion; psychological distress (e.g., Anxiety and Depressive Disorders); hypothyroidism; medication side effects; and vitamin B-12 deficiency.

The details assist with the bigger picture

Neuropsychological assessment develops a profile of your brain health by examining a range of cognitive domains. Understanding areas of strength and weakness help explain why you are struggling. A consultation with a neuropsychologist can answer important questions about your memory such as distinguishing between age-normative changes, symptoms more reflective of mild cognitive impairment or dementia, as well as changes associated with a medical condition. We offer guidance and practical recommendations to assist you and improve your functioning, identify necessary accommodations, or inform you about questions of competency such as being able to independently make important decisions about living (e.g., medical, financial).

Prevent cognitive decline by keeping yourself fit

One key to brain health is to remain active and fully participate in life. This continues to be the message from many research findings on optimal brain functioning in the later stages of aging. Studies have shown that you can help protect against cognitive decline and reduce the risk of dementia by maintaining good general health habits.

For example, challenging yourself with both mental (i. e., learning a new language or instrument, taking classes, playing bridge) and physical fitness (increases blood flow to the brain), eating healthy, and engaging in regular social/group activities, can all lead to improved brain functioning. Additionally, being more engaged will bring more joy to your life and have positive reverberations for yourself and your loved ones.

Please contact us to find out more about Memory and Aging.