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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
Number of People Diagnosed
(in millions)
70
60
Alzheimer's
MCI
50
40
30
20
10
0
2000
2010
2020
2030
2040
2050
Year
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
• 60-64
0.3%
• 65-69
0.9%
• 70-74
2.0%
• 75-79
4.1%
• 80-84
11.7%
• 85 & older
22.8%
All Dementias
1%
2%
4%
8%
16%
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
The Course of Dementia
Rate of memory decline increases 5.1 years before
dementia diagnosis (Hall et al, 2000)
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
Induction
Latency
Normal
Aging
Cognitive Performance
MCI
Subtle
Signs
Profound
Impairment
Diagnosis
15
10
5
Years Prior to Diagnosis
0
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
Sensory
Memory
Memory
Search
Episodic
Memory
Memory
Size
Visual
Memory
Temporal
Memory
Cognitive Research
Encoding
Memory
Framing
Numerical
Memory
Working
Memory
Memory
Under Stress
Autobiographical
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 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
Performance
Case Study 1: Mrs. H.
3.0
2.0
Treated
1.0
0.0
Normal course
-.1.0
-2.0
-3.0
Problematic course
Time 1
assessment
Time 2
assessment
Denotes time of first diagnosis
Time 3
assessment
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
910.962.7898
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