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Thorough evaluation can sort out cognitive changes

A man noticed changes in his wife of 60-plus years. She was not able to finish her sentences, repeated the same stories over and over, took long naps daily and was “captivated by television,” he reported. They had been to their primary physician, a doctor they've known for many years. Laboratory work was done, but nothing was diagnosed. Her husband wondered what else they might do in order to get a better idea of what was happening with her memory and abilities. At that point, it was suggested that an evaluation by a neuropsychologist might be in order.

If you are concerned about changes in someone’s ability to think, follow directions, or make good decisions, this assessment might be something to explore. Many times over the years, this evaluation has proved extremely helpful to families who might be considering some form of dementia as the underlying problem.

Here in Ashland we are fortunate to have a licensed psychologist, Dr. Brad Kauder (www.drbradkauder.com; 739 N. Main St.; 541-488-8988) who has provided neuropsychological and other services in the Rogue Valley for more than a decade. Here’s what neuropsychologists like Dr. Kauder are able to do (from his website): They “evaluate brain function by objectively testing memory and thinking skills, to achieve a clear characterization of a patient’s pattern of relative strengths and limitations.”

Dr. Kauder will conduct all phases of the neuropsychological evaluation himself — including the administration of tests. The information he provides allows for more accurate diagnoses and selection of more effective treatments. These evaluations can serve to inform important healthcare and/or legal decisions. In Medford, there are other neuropsychologists who also conduct these evaluations. Southern Oregon Neuropsychological Clinic (837 Alder Creek Drive, 541-608-3878) has several practitioners available to help in this area.

I have often referred people for just this sort of evaluation. The results of this extremely thorough testing, followed by a detailed written report, have been vital in pre-planning for the person’s changing needs. The primary physician can also follow up on medications, if needed. Once this testing is complete, it is also suggested that it be repeated in about one year, to track any changes or improvements. Medicare pays for the majority of this testing, but there is usually some cost to the person, perhaps a few hundred dollars. The value of knowing what is really going on is priceless, of course. I've been a fan of these evaluations and would not hesitate to recommend it for a clearer view on the functioning of someone’s mind and cognitive processes.

In addition to getting a clear understanding of what is underlying changes in memory or mood, someone wrote to me asking about physicians who generally specialize in aging adults. I had to tell her that we do not have any geriatricians here locally, but that many of our internal medicine and primary physicians do a great job with this population. You need to find one who is willing to understand the challenges families and patients face when some form of cognitive impairment is diagnosed.

The Alzheimer’s Association has a wonderful resource on their website. They have an excellent brochure on how to work with your physician at  www.alz.org/alzheimers_disease_visiting_with_your_physician.asp. Knowing how to communicate is primary with this group of patients, and the family can help by reading articles like this one. The local Alzheimer’s Association office in Medford also has many booklets, and can be reached at 541-772-2230.

By the way, when I have asked why we don’t have any geriatricians here, given the large retirement population, I’m told that it basically has to do with the limited Medicare reimbursement for services. That seems unfortunate, but if services such as Dr. Kauder’s are accessed, families can come to a clear understanding of what they are facing. We may not have everything that’s available in higher population areas, but what we have is mighty good.

Ellen Waldman is a certified geriatric care manager. Email questions about aging and Ashland-area aging resources and column suggestions to her at edw@ashlandhome.net.