What is the point of seeing a neuropsychologist?

Posted by crankyyankee @crankyyankee, Jul 9 8:52am

I have commented about this before, but have never asked that question. My 92 year old husband, dx'd in 2019 with mixed dementia, was referred to a neuropsychologist at Yale by the neurologist he saw initially. Ten minutes into the interview, my husband terminated it saying it was insulting to his intelligence and he would not continue. The neuropsychologist tried to get him back in track, but no dice, so we went home. He later called to offer any help we needed and I asked him whether the purpose exam was to help my husband or to advance research. He didn't give me a satisfactory answer about it being a help to my husband, so I wasn't regretful about the termination of the interview. Honestly, the best help we've had is from his geriatrician and especially the APRN in the practice whose mother has Alzheimer's so she knows what she's talking about. And these groups, online and in person. For a condition that can really only be managed, I cannot fathom how a 2 hour interview with someone who has never met the patient, not lived with them 24 hours a day for years, can help. His original neurologist suggested going to the senior center for socialization. My husband's primary care doctor (for 20 years) would have known that he wouldn't have done that BEFORE he developed Alzheimer's, so taking him into a situation like that would only be stressful, it seems to me. Am I being defensive? I don't think so. I do not regret for one minute the way I'm shepherding my husband along this journey, paying attention to where he "is" on any day, hour or minute and adjusting appropriately. I guess it bothers me that caretakers may be being given false hope - that a neuropsych exam will somehow change the trajectory of the disease. Interested in hearing rebuttals to my assessment of the exam. I'm open-minded!

Interested in more discussions like this? Go to the Caregivers: Dementia Support Group.

@cbisman

Thank you for your comments. I feel like people look at me like I have 3 heads when I pose this very question.
I heard about an "adult daycare" program near me from someone in a dementia support group. I took my 74yr old husband for an assessment, which showed severe dementia. This was simultaneously shocking and validating. He goes 3 days per week. The first two weeks he complained that they were all crazy and messed up. Now he enjoys it! He's not the same man he used to be. They meet him where he is today. He feels safe and supported, and comforted by the routine. I'm taking his to his neurologist this week for the first time since Jan 2023. I need a letter from him so that I can activate my POA for financial matters. Otherwise, I'm hoping for some advice on whether he is ready for memory care. I don't expect a definitive answer.

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Welcome, @cbisman. Have you been able to make an appointment with a neuropsychologist?

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@janet7

This is a short definition of what a Neuropsychologist does:
Neuropsychologists are trained to assess, diagnose and treat psychological conditions with brain-based conditions (e.g., DEPRESSION, ANXIETY, PTSD), Neurodevelopmental conditions (e.g., AUTISM and ASPERGER SYNDROME), Educational issues (e.g., DYSLEXIA, DYSGRAPHIA, IEP/504 accommodations), Neurodegenerative disease (e.g.
DEMENTIA).
I personally have not heard of this specialist before but when my husband had depression, we made an appointment with a counselor who was not trained in the knowledge of diseases such as Dementia. He did get better, but if he is depressed again, I would want him to go to a Neuropsychologist, because we know he has Dementia but what is he suffering psychologically? I see what my husband is going through because he is aware of what Dementia is doing to him and he gets very despondent when he can’t do what he wants - and worse, he knows there is no cure. I believe mentally it is horrendous for him and others to have to face the fact that they are sick and life for them will never be the same. They are afraid because life is changing for them and they don’t have any control over it.
Instead of them living their “Golden Years”, they will eventually not know where they are, who you are, not even know themselves. They will end up only being able to lie in bed and sleep. So the psychological aspect of Dementia is just as important to me as dealing with the caretaking of his Dementia.

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We joke that the Golden Years are rusty! 😆

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@davejr

I just was told by a neuropsychologist that you can have MCI and Alzheimer's simultaneously. Also, he said that highly functional individuals can score perfectly on the 30 question test and still have Alzheimer's--which explains why I had to fight with the neurologist to be referred for testing. Even Stanford told me I scored "exceptional for a person of my age" and said I was told I would never get Alzheimer's even after 3 different years of testing when I knew I was declining. It was a waste of many years of neuropsychological testing. But, you need a diagnosis for insurance coverage. It took the scans to change the conversations. Yes, it is depressing to learn you have dementia, but I found it comforting to get a firm diagnosis. I am also comforted by knowing that I will not lie in bed for years before I exit this life. The US states that allow 'death with dignity' unfortunately require a max of six months prognosis until death and that you are coherent enough to request assisted death a couple of times before they okay it. Next week I am going to Switzerland to check out Dignitas which doesn't have the catch 22 limitations that exclude individuals with dementia. Unfortunately, the travel costs and fees are expensive. But I will not lay there for years and die the painful for all deaths that my mother and grandmother did. Good luck and best wishes to all caregivers and patients who suffer.

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I hope you will post and let those of us on a later train (so to speak) what you learn. It is inhumane that we must endure the expense and loss of all dignity to languish for years and years. I’m suspicious that the medical and nursing home industries are being an obstacle to a compassionate end on this country.

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