Neuropsychology Refocusing Senior Care
By: John Sewell, East Tennessee Medical News
The ever-increasing population of senior citizens has ushered in a host of new areas of focus for healthcare professionals. When we think of healthcare for seniors, we usually think of maintenance of the physical body, such as the heart, the vertebrae, and digestive organs—all the while glossing over the fact that the brain is in fact the body’s most important organ.
Dr. Christopher Young, Clinical Neuropsychologist for Chattanooga’s Siskin Hospital for Physical Rehabilitation, is hoping to change that focus. Young explained that dealing with brain disorders is becoming a primary concern for physicians handling senior care. Siskin currently boasts four clinical neuropsychologists on its staff.
“As of 2010, there were around 40 million adults over age 65,” said Young. “And the 85 to 94 year old group is the fastest growing segment of that group because people are living longer. The lifetime incidence of developing dementia for seniors is 15 percent or higher. And after 85, nearly 50 percent of that population has some stage of Alzheimer’s.”
Alzheimer’s disease is the primary neurological challenge for senior citizens, although there is certainly a host of other challenges. For the analysis of disorders of the brain, clinical neuropsychologists are fast becoming the go-to group of diagnostic physicians dealing with neurological health for seniors.
“Clinical neuropsychology is really focused on characterizing the behavioral manifestations of brain dysfunction,” explained Young. “As clinical neuropsychologists, we have developed tools and methods for objectively measuring brain function—that includes memory processing, memory retention, visual processing, problem solving, and certainly the personality itself.
“Memory problems are the most common complaint,” Young continued. “People can have memory problems in a lot of ways. People with Alzheimer’s typically have problems with encoding memories. Other people may also have problems with processing speed or attention. Those factors work in sync because if a person has a hard time paying attention, it’s also hard to remember things.”
Neurological disorders for seniors most often manifest themselves in the form of memory lapses. Young explained that clinical neuropsychologists are in the business of doing detective work to diagnose brain disorders.
“The initial evaluation is multifaceted,” said Young. “Certainly, one of the important pieces for us is to get outside medical records. With aging populations, it’s good to have a family member or close friend along at the evaluation to provide corroboration for self-report. We would try to establish what symptoms a patient might have and the course of those symptoms, what underlying health issues might be relevant, and what medications the patient might be using. We would of course look at any risk factors, such as hypertension, diabetes, and sleep apnea. All those pieces begin to paint a picture of what concerns or changes might apply to the patient. From there, we would usually set up a time to make formal assessments of those abilities.”
Although the bulk of the work done by clinical neuropsychologists is treating disorders after diagnosis, new ways of dealing with brain health proactively are emerging. Dr. Paul Nussbaum, Clinical Neuropsychologist and Adjunct Professor of Neurological Surgery at the University of the Pittsburgh School of Medicine, is spearheading a hands-on, preemptive approach to brain health.
Nussbaum has mounted an effort to make brain health part of a regimen of lifelong proactive health measures. He explained that a proper approach to brain health should focus on five areas: nutrition, physical activity, mental stimulation, socialization, and spirituality. While Nussbaum is indeed excited about diagnostic developments for clinical neuropsychologists, he stresses that preventative measures should be emphasized as well.
“The tools that we use on the clinical side [of neuropsychology] have become much more sensitive,” said Nussbaum. “The research that neuropsychologists are doing is helping to identify those who are at risk for developing dementia. We’ve been deeply involved in helping with treatments, in terms of understanding functional abilities, and in helping with the basic question of ‘can my parent still live alone?’ These are all areas that neuropsychologists have helped. But I don’t think we’re necessarily doing enough in terms of developing proactive measures for brain health.
“We’ve got to begin the process of brain health promotion really early in life,” Nussbaum continued. “We have to create incentives for people to continue to learn, to eat healthy, and to engage in physical activity.
“The neat thing about brain health is that it’s really not rocket science,” enthused Nussbaum. “It’s really kind of practical stuff. People want to maintain having access to their life story. And these brain diseases—what they fundamentally do—is remove us from our own life stories—from our experiences with our loved ones. We tend to lose our loved ones because we don’t see them as familiar people anymore. We need to promote the understanding of brain health so that we can keep people involved in the story, so to speak.”
Nussbaum recently spoke in Knoxville to 18,000 participants at the 2012 Destination Imagination Conference and is scheduled to speak in the East Tennessee area again when he visits Johnson City on December 7th.