There is the problem. And then there’s the solution.
People with mild cognitive impairment know what the problem is. It can be harrowing when your mind begins to fail.
The solution doesn’t begin until you have a diagnosis.
You walk into a room and you can’t remember why you went there. Someone tells you something, and five minutes later, you have to ask again.
The problem begins when you notice these signs. But the solution doesn’t begin until you have a diagnosis, and that’s what I want to talk about today with my special guest, Dr. Michelle Papka, who is an expert in diagnosing MCI.
Hi, I’m Tony Dearing, of GoCogno.com, the website for people with mild cognitive impairment.
For people with MCI, that diagnosis is essential. I talk about it a lot in my book, “I Want My Mind Back: The Go Cogno Approach to Halt or Reverse Mild Cognitive Impairment.”
A good diagnosis represents the first, most fundamental step in confronting your MCI.
A good diagnosis represents the first, most fundamental step in confronting your MCI, and giving you the best possible chance to slow, halt or reverse whatever cognitive decline you’re experiencing.
But how is MCI diagnosed? What goes into a proper evaluation? For that, I turned to Dr. Michelle Papka, founder of The Cognitive and Research Center of New Jersey.
She joined me on a Facebook Live recently, and today, in the first of two videos, she shares great insight on that. I began by asking, why is a diagnosis so important? Here’s Dr. Papka:
Dr. Michelle Papka: “All forms of cognitive functioning decline over the lifespan. And it’s important to understand whether the changes we’re experiencing, first of all, are a result of normal aging or something else.
“The other thing is that there are many different things that can cause mild cognitive impairment and it would be important to understand what is causing someone’s mild cognitive impairment so that we can plan the right types of interventions.
When people have MCI, either they may dismiss it or their doctors may dismiss it.
“And what I often find is that when people have mild cognitive impairment, that either they may dismiss it or their doctors may dismiss it or family members may dismiss it.
“And that’s because, by definition, when someone has mild cognitive impairment, they’re still functioning. So they may notice there’s something going on, and there may be some objective measure that there’s something going on, but they’ll still able to function in their daily roles which may prevent them or people around them from giving it the attention and seriousness that it should get, because some kinds of cognitive impairment may be reversible or addressed and for others, there may be steps that people can take to help moderate future cognitive loss.”
Key elements of a proper evaluation and diagnosis
1. Detailed questionnaire to gather your history
Dr. Papka: “When someone comes to use for a neuropsychological evaluation, we will begin by asking them to fill out a very detailed questionnaire for us to get an idea of their history and what’s been going on with them even before they walk in the door. We will also ask to receive copies of any relevant medical records so that we can review that as well.”
2. Bring a family member of trusted friend (optional)
Dr. Papka: “When they first come in, we ask if they are willing to bring someone else in with them, whether it’s a family member or friend or someone who knows them well, if they are comfortable doing that, we encourage and welcome it. Some people don’t want to do that, and that’s OK too.”
3. In-depth interview with person who has MCI
Dr. Papka: “We spent 45 minutes to an hour just kind of getting to know the person and understanding what it is that’s troubling them, what they’re noticing, what they’re finding difficulty in, and also getting a good sense of what that person’s baseline functioning is.”
4. Battery of cognitive tests
Dr. Papka: “And after that, we will administer to them a battery of tests, much more in-depth than the MoCA or the Mini Mental State Exam (MMSE), which are good potential screening measures but are very cursory.
We administer a battery of tests to see how someone is functioning across a range of cognitive domains, like attention, memory, language skills.
“We will administer a battery of tests so we can see how someone is functioning across a range of cognitive domains, so that would include things like attention, memory, language skills, utilization of visual and spacial information, and executive skills, which are used in things like planning, organizing, being able to think flexibly.
“And we want to see how people are doing in those domains relative to other people their age. They should be performing like other people their age across the lifespan and they should be performing in the same general category they would have been performing prior to noticing any loss. For example, if somebody always functioned in a high average range compared to their age group, they should always function in the high average range, whether they are 20, 50 or 90. So they should stay in that same relative spot on the curve.”
5. Person returns to receive results of testing
Dr. Papka: “So we will look at that, and then we put all that information together and then have the person come back and we will go over with them the results of the testing and our impression as to what we may think is going on and we will put together a pretty comprehensive list of recommendations anything from a medical recommendation to require additional medical followup, resources in the community that may be of help, pieces of literature, whether we’re referring them for psycho-education, to get more information. I usually do those sessions with a social worker jointly, so we’re each adding our own piece.”
6. The importance of a multidisciplinary approach
Dr. Papka: “The other piece I want to add here is that we work very closely with neurologists, psychiatrists and primary care physicians, geriatricians, and because we also happen to be a research site and have access to different types of brain imaging and other kinds of lab assessments, the other piece of the evaluation, whether it’s done through us some way or through a collaborating physician, is to potentially get other pieces of information like results of blood work, results of a brain MRI, or a more specialized type of image.
“What we want is to have an understanding of the cognitive, behavioral and clinical symptoms, and then we also want to have as many what we call biomarkers, biological information, to see whether those things correlate or support each other in some way to help us arrive at a potential diagnosis.”
So as you can see, there’s a lot that goes into a proper diagnosis.
So as you can see, there’s a lot that goes into a proper diagnosis. And I hope that’s what happened for you. But we know that many people aren’t getting that kind of evaluation, or even anything close to it.
If you’re one of those people, let’s do something about that. Next week, Dr. Papka will be back to talk about how to get the evaluation and diagnosis you deserve. I hope you will join me for that.
See you next Sunday. Until then, as always, be kind to your mind.