Detecting Individual Differences in Changes in Memory Functioning Dr. Len Lecci Professor of Psychology University of North Carolina Wilmington Director of Clinical Services Memory Assessment

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Detecting Individual Differences in Changes in
Memory Functioning Dr. Len LecciProfessor of
PsychologyUniversity of North Carolina
WilmingtonDirector of Clinical ServicesMemory
Assessment Research Services
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Trends in MCI and Alzheimers
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Unvergatz et al, 2001
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The incidence of dementia
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• Less than half of the population (45) aged 84
  and older is cognitively normal - NIH, 2001
• Prevalence Rates
• Age Alzheimers Disease All
  Dementias
• 60-64 0.3 1
• 65-69 0.9 2
• 70-74 2.0 4
• 75-79 4.1 8
• 80-84 11.7 16
• 85 older 22.8 30-45
• Rates for each person would also vary depending
  upon your risk factors, genetic predisposition,
  etc, all of which can double, triple, or
  quadruple your risk.
• Prevalence Rates based on the most recent Report
  to the Surgeon General, 1999

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Degenerative Pattern of Neurons
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The Course of Dementia
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• Rate of memory decline increases 5.1 years before
  dementia diagnosis (Hall et al, 2000)

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New and Emerging Treatments
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• New Medications
• Cholinergic Enhancers (e.g., Aricept,
  Reminyl/Razadyne, Exelon, Cognex)
• Neuroprotectors/cell death blocker (Namenda)
• Anti-beta amyloid drugs (Phase III trials)

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Early Detection and Treatment of Memory Loss
Greatly Improves Quality of Life
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Benefits of early detection/intervention
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• At current rates of nursing home admissions, a
  one-month delay would save more than 1 billion
  annually in Alzheimer care costs alone in the
  U.S.
• Treatments that delay onset by five years would
  reduce the number of individuals with Alzheimers
  disease by nearly 50 after 50 years.
• Alzheimers Association and the National
  Institute on Aging

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Normal Aging
Profound Impairment
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Do I have a memory problem?
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• Normal forgetting or early signs of a serious
  problem?
• Subjective self-assessment of memory functioning
  based on anecdotal experiences (long vs. short
  term memory)
• Research Individuals with cognitive impairments
  (memory deficits) do not typically realize that
  they have these problems
• self-reported assessments are ineffective

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Detecting dementia during routine physical exams
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• lt 3 of those evidencing the early stages of
  dementia are detected during routine physical
  exams
• lt 25 of those evidencing moderate to severe
  dementia are detected during routine physical
  exams
• Report to the Surgeon General, 1999
• Time constraints
• Limited specialized training in memory
  evaluations
• Inaccurate selfreport of patients
• Limited use of standardized measures
• Influenced by verbal skills of the patient
• One dimensional view of memory

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Multi-Factorial View of Memory
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Most effective method for memory screening
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• Using comprehensive, standardized, and validated
  tests to screen for memory impairment
• Thorough assessment of memory Assessing visual
  and auditory memory, immediate and delayed
  memory, memory capacity, memory learning curves,
  etc.
• Approximately 45-60 minutes to administer (
  scoring)
• Administered by a trained psychologist
• Allows for comparisons with people of the same
  age
• Assess other cognitive areas as well
• Assess more than once

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Case Study 1 Mrs. H.
3.0 2.0 1.0 0.0 -.1.0 -2.0 -3.0
Performance
Normal course
Time 2 assessment
Time 3 assessment
Time 1 assessment
Denotes time of first diagnosis
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Who should be evaluated for memory problems?
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• Anyone 55 or older To establish a record of
  functioning.
• Risk Factors include
• 1) Family history of dementia (48 if parent with
  early onset)
• 2) Type II diabetes, high BP, high cholesterol
• 3) Known or suspected CNS dysfunction (stroke,
  tumor, etc.)
• 4) If undergoing treatment (medication, surgery)
  that may effect a cognitive or behavioral change
• 5) Those already diagnosed with dementia to
  optimize treatment outcomes (i.e., more
  aggressive treatment).

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MARS is located in the UNCW Executive Development
Center in the Northeast Regional Library building
at Landfall Center
910.962.7898
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Educational opportunities

• Undergraduate students completing advanced
  practicum placements
• PSY 451 (3 credits per semester)
• Graduate students in psychology completing
  practicum and internship (hours towards licensure
  as LPAs)
• Opportunities for extensive testing experience
  and weekly grand round reviews
• Exposure to repeat testing with a sample of
  normal aging and progressive dementia cases
• Graduate students from the school of business
• Interns and class projects
• Post doctoral training
• Job opportunities for UNCW graduates

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