Assessment and Diagnostic Services

Our Philosophy and Point of View

 

As neurobehavioral and psychobiological research and treatment methods have been applied to the harsh realities of aging, the fields of neuroscience and neuro-psychology have risen in visibility and importance.  This is the result of their abilities to more specifically explain the processes of learning, memory, cognition, and intellectual functioning.

 

The Center for Bio-Behavioral Science was borne from these scientific disciplines. CBBS is dedicated to the neuropsychological assessment and treatment of disorders that impair memory, cognitive, and intellectual function in older adults as well as to those disorders that impair attention and learning in young and middle aged adults.

 

We are capable of finding hidden problems that disturb or disrupt brain functions which control memory, learning, and the ability to focus and maintain attention.  We are also dedicated to the diagnosis and treatment of complex mood and anxiety disorders that have not responded to treatment.

 

Changes in brain functioning are natural consequences of the aging process.  Just as our bodies slow down with age, our minds also slow down.  We need to expend greater effort to learn new things as our memory processes no longer work with the efficiency we had earlier in life.  This is particularly true of forming new long term memories.  We become more easily distracted, and we have a harder time focusing our attention on more than one task or thought at a time.

 

However, there are significant differences between normal aging and early neurodegenerative diseases in terms of quality and quantity of change.  We have powerful diagnostic tools that allow us to identify those differences and to assess the entire set of cognitive and memory components.

 

In this way, we can uncover specific abnormalities as well as relative strengths and weaknesses in these various areas of brain function.  We then assemble the data we retrieve from neuro- psychological testing into a comprehensive diagnostic assessment of your cognitive and intellectual functioning.

 

Modern medicine has grown more powerful in its ability to preserve organ function and to extend lifespan.   Longevity is something most of us desire.  Yet, long life can become a mixed blessing if modern science fails to solve the problems that neurodegenerative disorders, particularly the dementias, have on quality of life and on our financial stability.

 

The fastest growing segment of our population is comprised of those people who are 85 and older.  This is a staggering truth.  Yet, if we cannot better preserve brain function what do these medical advances really mean? Today, it is possible to live “too long.”  By that we mean that neuro-degeneration in the form of Alzheimer’s disease and the other dementias can turn a physically healthy person into an empty shell and wreak havoc on families.

 

To a great extent memory disorders, including the dementias, pose the greatest medical and social challenges to the modern world.  Spending the final years of life impaired intellectually, cognitively, and emotionally are ironic rewards for surviving serious illnesses or preventing diseases and accidents.  And the cost of providing care to so many millions is prohibitive for families as well as for our counties, states, and Federal government.

 

Our mission is to identify these problems at very early stages so that they can be slowed down.  At the same time we are identifying high risk patients.  We can detect risks of neurodegenerative disorders as much as five years in advance of visible, noticeable symptoms.

 

As new treatments emerge, people at high risk can be first in line to receive medicines that have shown promise in clinical trials.  They can also be first in line to receive experimental treatments that are being considered for FDA approval. This is information that can only be helpful to each one of us in the long run, yet so many patients and health professionals shy away from the specialized tests that can reveal these early cognitive changes.

 

Knowledge is power.  Warnings of early neuro-degenerative changes will make it more likely that you receive help in slowing down the rate of cognitive and intellectual loss.  Then, high risk patients can move to the front of the line as new therapies surface.

 

There is a very good reason why Medicare has issued a mandate for all seniors to be tested annually for cognitive problems.  It is a policy based upon calm, objective knowledge and creates the highest probability of helping people who are at high risk of developing future problems.  The Center for Bio-Behavioral Science can detect these early changes in memory and cognition.

 

The staggering truth is that few seniors are ever adequately examined for memory problems and cognitive function when they see their primary care physicians.  The result is that approximately 50% of people with Alzheimer’s disease never know they are ill until the symptoms have progressed to a point where the best that can be offered is to briefly slow down a degenerative process that has already taken a large toll on intellectual abilities and is causing psychiatric symptoms and disorders. While even this relatively late diagnosis is helpful, it can’t compare to finding evidence of problems 4-5 years before they are severe enough to cause disturbing problems.

 

Mental suffering is sadly misunderstood.  Depression is as painful a disorder as any physical illness.  Anxiety disorders in the form of Obsessive-Compulsive Disorder, panic, generalized anxiety, phobias and social anxiety are chronic, recurring disorders that rob people of the quality of life and cause them untold pain and suffering.

 

These psychiatric problems also can occur as part of a degenerative disorder of the brain such as Alzheimer’s disease or another dementia subtype.  CBBS doctors are able to help diagnose and identify causes of these psychiatric problems.  Because we can identify whether they are causing or caused by cognitive disturbances, our treatment success can be maximized and the person who seeks help can be optimally treated.

 

What Assessments are done at CBBS? How are they Performed?

 

Neuropsychological Assessment

 

Neuropsychological assessment provides detailed information about brain function and insight into behavior disturbances associated with impairments of those processes in the brain that regulate cognitive and memory functions.  A neuropsychological evaluation involves the use of a detailed clinical interview that almost always includes loved ones and family. From this interview we are able to generate a strategy to uncover the problems and disorders that are most likely causing the symptoms and dysfunction that bring patients to our center.

 

Reports from schools, family, friends, co-workers, and other people who are familiar with the affected person are of critical importance.  They provide information and insight into behavioral disturbances and into disturbances in thinking and reasoning.   Prior testing is very important because it serves as a complex indicator of brain function earlier in time and allows us to assess change.  Baseline testing is very important since we can use it for future comparison.

 

Neuropsychological test batteries are then designed to elucidate the chief complaints and to assess the levels of performance of various brain functions and specific brain areas that relate to the information we gather from the initial interview.  Together, these tests can tell us about the integrity of a person’s mental abilities, and particular patterns of performances can help pinpoint the presence of different forms of brain dysfunction, including dementias.

 

The tests are done with paper and pencil.  You will be asked to perform memory functions, copy diagrams, and identify patterns of numbers and words as we test each area of the brain that has input into the cognitive processes that we believe need assessment.  Other tests may specifically test personality and the presence of psychiatric symptoms and disorders.

 

The sensitivity of these tests can identify subtle or early problems that may not be otherwise observable or obvious.  They can also document a person’s skills and abilities as a means of objectively measuring later changes and responses to medications.  Other tests given at the same time accurately identify psychiatric symptoms including depression, anxiety, and psychosis.

 

Neuro-radiology

 

At CBBS we first provide patients with neuro-cognitive screening tests which give us a great deal of information.  When tests indicate that a cognitive disorder may be present even in the earliest stages, we can refer you to a neurologist or recommend to your primary care doctor that specific neuro-radiologic tests be performed to confirm diagnosis.

 

The field of neuro-radiology has progressed rapidly and offers exciting insights into the structure of the brain as well as the function of the brain.  New tests like functional MRI combine both.  These tests are very helpful in diagnosing dementia and structural abnormalities of the brain. MRI scans provide specific information regarding the structure of our brains and can help with the diagnosis of Alzheimer’s disease and other conditions that cause dementia–particularly vascular dementia and strokes.  Functional radiological tests such as SPECT and PET also yield information regarding cognitive impairment and psychiatric disturbances.

 

Medicare’s mandate for an annual cognitive screening exam should be performed with a carefully designed neuro-psychological test battery which can screen for Mild Cognitive Impairment.  If this condition is identified, neuro-radiology can then provide even more concrete evidence of risk regarding the potential to develop dementia in the future.

 

New and exciting applications of PET and fMRI scans may make it possible to identify those people at high risk of Alzheimer’s disease many years in advance.   While this is frightening to many people, the combined use of neuropsychological testing and specialized scans can lead us to identify at risk patients very early.  These patients can be treated with prescription vitamins special medications approved for Alzheimer’s diseasememory training, and alternative medicine interventions to help slow the progression of this impairment.

 

We firmly believe that slowing the progress of neuro-degeneration and identifying those at risk greatly enhances the chance that they can be saved from developing full blown dementia.  New medications are being testing that can be given to high risk patients and experimental medications in clinical trials might also be useful to such patients.  People who are not identified as high risk won’t be first in line to get new therapies.

 

We see knowledge as power.  Fear leads to ignorance and what we believe to be dangerous inaction and passivity.  Cognitive problems should not be approached as incurable, horrible fates that are better left unknown.  Avoiding cognitive and memory assessment is ignorant neglect rather than wise guidance.  Such mistakes have been made before.  HIV testing was surely a recent example of this.  We know the story there. Those that knew they were infected were ultimately able to receive help that stopped the disease in its tracks.  A lack of knowledge—avoidance–was fatal for so many people.