Cognitive declines in older age can be hard to pinpoint. They often build gradually, and it can be hard to distinguish a “senior moment” from a significant disorder. There are several kinds of neurodegenerative disorders that lead to greater and greater cognitive and motor impairment, including Parkinson’s disease and multiple sclerosis. But the most common of these are the dementias, including Alzheimer’s disease, Lewy body dementia, and frontotemporal dementia (which can actually begin developing as early as 40 years old but often isn’t recognized).
Though many people think all dementias feature prominent memory loss, this isn’t always the case. The differences in symptomatology and onset help to distinguish the different disorders and help you to predict their course and prognosis.
Alzheimer’s disease is the most well-known of these, and many of us have witnessed a loved one’s decline from Alzheimer’s. Memory loss is the classic symptom for this kind of dementia; an individual may begin by forgetting recent conversations or the names of new acquaintances and they will progress to the loss of even long-held memories and the ability to function independently. People with Alzheimer’s may also be disoriented, have trouble thinking in abstract ways, and make poor decisions.
Though memory problems can also be experienced in Lewy body dementia, memory loss is not usually a central symptom. Instead, people report visual hallucinations, problems controlling their body movements (leading to tremors and a shuffling walk), and some problems with automatic systems in the body, like balance and digestion.
Frontotemporal dementia often first manifests as surprising personality changes, including becoming disinhibited and socially inappropriate, showing a loss of empathy, or seeming uninterested in most things. Symptoms become progressively worse and more pervasive over time and can lead to problems with speech and language and movement problems like tremors and muscle spasms.
Though there are no treatments for these dementias, programs can help people maximize their independent functioning and learn new ways of completing tasks. An excellent neuropsychological evaluation is essential for all of this. Cognitive testing helps establish baseline strengths and weaknesses. Repeated memory, executive function, and language testing will help to establish baseline functioning and to document declines over time. Personality and coping style testing will give service providers insight on how to maximize quality of life and avoid accompanying depression and anxiety. The neuropsychologist will become an important part of the team to help someone achieve optimal functioning for as long as possible.