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Evidence-based neurocognitive (neuroaffective, neurobehavioral) assessment identifies key issues and provides relevant recommendations for treatment. Such insights normalize changes which occur as we age, and can be fully understood, managed, and treated. Like MRI neuroimaging studies address the structural integrity of the brain, neurogeriatrics provides core detail about cognitive changes, those that result from abnormal and normal processes. 
Neurocognitive impairment can include:
  • Having trouble remembering
  • Learning new things
  • Concentrating
  • Making decisions
Such impairments can range from very mild to very severe, (or more common to less common).
With Mild Cognitive Impairment (or "MCI") we may begin to notice changes in cognitive functions, but we're still able to do our everyday activities. Major Cognitive Impairment (some which include the "Alzheimer-type"), do not necessarily follow MCI, but can lead to losing our ability to understand the meaning or importance of something, our speaking and writing skills, and the ability to live independently. 
Unrecognized impairment is surprisingly common as we age, yet does not suggest a dementia. However, even mild impairment includes risk factors for:
  • Medication non-adherence such as under-dosing, over-dosing and mixed-dosing
  • Inadvertent but poor compliance with general healthcare treatment recommendations
  • Difficulty navigating day to day tasks, demands and decisions
  • Individual, family and caregiver stress
Important questions we hear from patients, families, and healthcare providers:
  1. Is this normal, or something to be worried about? 
  2. She's having increasing memory problems; is there evidence of actual neurocognitive pathology, or can other reasons account for this?
  3. Are there intellectual, emotional or behavioral issues that could account for these possible deficits or complaints?  
  4. Can we document his baseline functioning to measure changes over time, including progress or recovery?    
  5. Is this some type of depression . . . maybe masked or underlying, contributing to all this? 
  6. If there are cognitive impairments, are the patterns consistent with a chronic medical concern like Arthritis, Diabetes or Pulmonary disease?  
  7. What does this mean for her everyday functioning, such as her ability to live independently?
  8. Can he follow a pre-surgical and/or post-surgical procedure? Stick with a medication or therapy protocol?  
  9. If there's neurocognitive pathology, can it be reduced or reversed over time?  
  10. Can you help us figure out what's going on, make recommendations, help us with treatment options?  
When considering the questions, it's important to remember that most folks over 65+ have a least one chronic, non life-threatening medical condition, usually accompanied by some fatigue, which effects even stable neurocognitive functioning. Alas, our brains are connected to our bodies . . . and each influence the other.
A sensitive picture of both the head and the heart, including all the nuances of what makes us who we are (our values, our career history, our personality style), results in an accurate diagnosis and prognosis, which in turn leads to viable, realistic opportunities specific to each individual.  
"I'm not so sure if I'd want to know! In truth, most of the time I hope to brush off any changes, like not being able to remember something, not being able to find the right word, the kids say I repeat myself, or the more time it takes for me to make what used to be simple decisions. Sometimes I'm anxious about asking for help, at my age I've heard enough bad news from all those doctors and nurses." 
"I learned that for the majority of us older and wiser folks, our minds are working pretty damn good for our age and what we've been through. If something takes a turn for the worse I can still decide to come up with some new or, you know, old ways to cope [laughs], ways I can work it out; my son calls those 'strategies.' I've learned to take a 'management' rather than a 'cure' approach, I make gradual adjustments, turn the radio dial just a little up or down, being honest with myself always, tell me the truth about what's working and not working, I'm betting I can live with the truth."   
"I know that if a time ever comes when things become worse, I need to know what's happened, how I can work with my doctors to stabilize things, to make reasonable progress, how I can help myself, how I can accept help from others, or just tell 'em no thanks. This makes all the difference. I might not always say it out loud, I've been around the block, I know from my lifetime of experience, if I avoid my own thinking, I'll end up feeling frustrated, angry, and just numbskull hopeless. I know I've got better options than that." 
The Neurocognitive Domains
Gnosis (an odd word, eh?) is the ability to recognize complex sensory impressions. It comprises the processing of sensory impressions, perception, interpretation and understanding. The term used when a cognitive disorder affects gnosis, is Agnosia
At its core, Memory is the ability to remember. Memory includes learning, storing, recognition and recall, with a difference between short-term and long-term memory (there are other types, as well). The loss of memory functions due to a cognitive disorder is called Amnesia (though this term is also used more causally, and incorrectly, in our culture).  
Language is the ability to understand and express the spoken and written. Language disorders are known as Aphasias. Impressive-type aphasia is also known as Wernicke's aphasia, while expressive-type aphasia is called Broca's aphasia
Executive functions include regulation and control such as initiative, intentionality, planning, judgement, the ability to form a comprehensive overview, and emotional control. The loss of these functions leads to, e.g., an overly simple or perhaps unsophisticated presentation as well as reduction in social skills.
Personality (or "Hmm, who's brain is it?") reflects the characteristics of an individual which apply at any time and in most or all situations, such as extraversion, agreeableness, openness, conscientiousness, etc. You may have noticed there is not a lot of consensus on what "makes" for a personality type; that said, neurocognitive changes frequently impact personality.   
Praxis comprises practical skills, automatic patterns of action and the coordination of movements. The term used when a cognitive disorder affects praxis is Apraxia.
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