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 & Research Services

Trends in MCI and Alzheimer’s Unvergatz et al, 2001

The incidence of dementia Less than half of the population (45%) aged 84 and older is cognitively normal - NIH, 2001 Prevalence Rates Age Alzheimer’s Disease All Dementias % 1% % 2% % 4% % 8% % 16% 85 & older22.8% 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

Degenerative Pattern of Neurons

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

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

Early Detection and Treatment of Memory Loss Greatly Improves Quality of Life

Benefits of early detection/intervention 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 Alzheimer’s disease by nearly 50% after 50 years. Alzheimer’s Association and the National Institute on Aging

Profound Impairment Induction Latency MCI Years Prior to Diagnosis Cognitive Performance Diagnosis Subtle Signs Normal Aging

Do I have a memory problem? 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

Detecting dementia during routine physical exams < 3% of those evidencing the early stages of dementia are detected during routine physical exams < 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 self–report of patients –Limited use of standardized measures –Influenced by verbal skills of the patient –One dimensional view of memory

Multi-Factorial View of Memory Cognitive Research Episodic Memory Temporal Memory Memory Search Sensory Memory Memory Size Memory Under Stress Working Memory Numerical Memory Autobiographical Memory Memory Framing Encoding Visual Memory

Most effective method for memory screening 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 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

Case Study 1: Mrs. H Time 2 assessment Time 1 assessment Normal course Performance Time 3 assessment Denotes time of first diagnosis Problematic course Treated

Who should be evaluated for memory problems? 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).

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

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

Knowledge Transfer Memory Assessment and Research Services is part of the UNCW Knowledge Transfer Initiative. This initiative, as part of Technology Transfer, is intended to facilitate the transfer of knowledge from the academic setting to the community