Blog - Memory Gains

Neuropsychological Testing for Adults

Thu, 04 Jul 2024 13:56:00 GMT

“There is a history of dementia on my dad side – my grandma. It was hard to watch her slowly deteriorate. It got to the point where she didn’t even recognize me. Lately, I’ve noticed my own memory problems, and my husband has commented about it too. Sometimes I wonder if I’m going to get dementia too. Are these the early signs or are my memory issues normal for my age? I am worried about it all the time and I’m not sure what to do.”

It can be difficult to determine whether your memory loss is a natural part of aging or the beginning stages of a neurodegenerative disease. One of the first steps may be to talk to your primary care provider; based on your symptoms they may refer you to a neurologist or a neuropsychologist. A neuropsychologist is a psychologist with special training in brain behavior relationships who will provide you with a comprehensive neuropsychological evaluation.

The Comprehensive Clinical Interview

The evaluation begins with a thorough clinical interview to understand when cognitive issues began, the course (e.g., does it worsen over time or fluctuate?), and the severity. One of the main questions is to determine whether these cognitive issues affect your day-to-day functioning. For example, are your memory problems impacting your ability to manage your finances? Were you once great with managing your finances but now you’re struggling to keep things in track? Is this a significant change from the past? The neuropsychologist will also ask you questions about your medical, family, and psychological history to figure out what may be causing these cognitive issues (and possibly ruling out what is not the cause).

It may be helpful to get collateral information by also briefly interviewing a current partner, adult child, or even a close friend that can provide additional information of some of your cognitive concerns.

Neuropsychological Testing

The neuropsychologist will then provide a variety of tests that examine different areas of thinking such as memory, attention, language, and executive functioning, etc. Some of these tests involves computerized tests, oral questions, and pen and paper tests. Testing may take several hours and is typically done in-person.

After testing, your performance in these tests is scored and then compared with people who are similar to you (basically those who are the same age, sex, and education). This is to determine whether you are performing similarly to your peers (in other words, to see if your scores are within normal limits). The neuropsychologist interprets your findings and prepares for the feedback session.

Feedback Session

You will come in for a third visit where the neuropsychologist will provide you information regarding the results of testing. The neuropsychologist will explain what are the likely factors that are impacting your cognition as well as tailored recommendations. There is opportunity to ask questions and determine what the next steps are.

The neuropsychological evaluation is a process that can takes hours, and can be tiring and stressful for the patient. However, an experienced neuropsychologist will guide you through the whole process step-by-step and help ease some of the anxiety. Many people I’ve worked with have found the evaluation to be interesting and engaging - some have even found the whole process enjoyable as it provided insight to their cognitive challenges.

Reduce your risk of dementia

Sat, 25 May 2024 15:53:00 GMT

Many of us know about Chris Hemsworth – best known for his movie star role of the superhero character, Thor. (Think long blonde hair, chiseled jaw, and giant mallet) Recently, I saw headlines about his documentary where he discovered he had two copies of apolipoprotein E (APOE) e4 gene, which is linked to an increased risk of Alzheimer’s disease. The APOE gene is responsible for producing a protein that carries cholesterol and other fats throughout your blood stream.

I can imagine the worry he must have felt after finding he had two of these alleles. However, there is positive news – knowing that he carries these two alleles, he can make lifestyle changes now that can reduce the risk of developing Alzheimer’s disease. The time to make these adjustments is NOW when you are in your 40s-60s – not when you have a diagnosis of Alzheimer’s disease.

Firstly, what is dementia? What is the difference between Alzheimer’s and dementia?

Dementia is a general, umbrella term used to describe a group of neurodegenerative conditions that are characterized by a worsening cognitive ability that can interfere with a person’s ability to function from day-to-day. Different types/causes of dementia include Alzheimer’s disease, vascular dementia, Lewy Body’s dementia etc. Alzheimer’s disease is the most common type of dementia and is caused by the buildup of a protein called amyloid beta that can ultimately cause cell death. People with Alzheimer’s disease have significant memory problems (difficulty learning new information), language and eventually loss of function.

Alzheimer’s disease is a devastating disease, but there has been growing evidence suggesting that there are modifiable risk factors – changes we can make to improve brain health that you can start in midlife - way before the thought of even having Alzheimer’s enters your mind. In other words, there are things you can do to delay or even prevent the risk of developing dementia in the future. In 2020, the Lancet Commission on Dementia Prevention and Care showed that there several modifiable risk factors suggesting that up to 40% of dementia cases could be prevented through lifestyle changes. Some of these include:

Cardiovascular risk – Having medical conditions such as hypertension, obesity, high cholesterol, and diabetes can increase a person’s risk of developing dementia. However, lifestyle changes including consistent exercise/physical activity, and improving nutrition can help.

Depression – Clinical depression can include debilitating symptoms such as low mood, fatigue, loss of motivation, changes in sleep/appetite, and feelings of hopelessness that can cause significant distress and affect relationships and work/school. Additionally, many people with clinical depression find themselves socially isolated, which is also a risk factor for dementia. Psychotherapy and medications may help alleviate depression.

Sleep – Additionally, other studies also determined the importance of sleep and its impact on cognition. Conditions like sleep apnea (when untreated) may also increase the risk of dementia. Cognitive Behavioral Therapy for insomnia (CBT-i) is considered a “first line” treatment to address sleep difficulties by targeting perpetuating factors that contribute to poor sleep. Practicing good sleep hygiene (and using your bipap or cpap machine when recommended by your doctor) can greatly improve your sleep and brain health in the long run.

Managing these conditions can greatly reduce dementia risk and promote good brain health.

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England) , 396 (10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6

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What is the Most Effective Treatment for ADHD?

Thu, 02 May 2024 21:23:00 GMT

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that begins before the age of 12, but symptoms may persist throughout adulthood. There are three subtypes of ADHD.

1. Predominantly Inattentive Presentation:

2. Predominantly Hyperactive-Impulsive Presentation:

3. Combined Presentation : symptoms include both inattention and hyperactivity-impulsivity.

These symptoms must cause impairment in functioning in school, work, or socially in relationships. Importantly, these symptoms cannot be better explained by another mental health condition. If you have been diagnosed with ADHD as a child, and you are struggling with inattentiveness or hyperactivity as an adult, you may assume your symptoms continue to be a result of ADHD. However, ADHD is often comorbid with other conditions such as depression and anxiety. Depression and anxiety may also affect your attentional abilities!

For example, you’re at work and your supervisor is telling you about a deadline for a project next week. You have a hard time paying attention to her because you haven’t started (anxiety), are unmotivated and lack the energy to do anything (depression), and you’re not sleeping well because of it all.

So, what is causing these attentional difficulties? Is it ADHD or depression or anxiety or lack of sleep or stress? It can be all the above!

If you are newly diagnosed, one of the first steps you may consider is medications as it may be a “quick fix.” Medications can helpful, however the most effective ADHD treatment includes a combination of medications, therapy and psychoeducation.

What would therapy for ADHD look like?

1. For those with attentional difficulties, having structure and routine is extremely important. This external structure can be implemented by utilizing a daily planner or calendar to keep organized and schedule things ahead. You will also learn strategies to set clear and realistic goals, prioritize tasks, and break down overwhelming tasks into manageable steps to maximize success.

2. Cognitive Behavioral Therapy (CBT) involves reframing negative thinking patterns and behaviors. CBT is not only effective in treating ADHD, but also depression and anxiety. CBT helps “slow down” your thinking so you can reflect on what is preventing you from making those deadlines, changing unhelpful thoughts to manage emotions, and learn problem solving skills.

3. Mindfulness-Based Exercises involve actively paying attention to your thoughts, feelings, and physical sensations in your body. With regular practice, this can help improve your ability to sustain attention. Mindfulness can also help reduce anxiety and stress as it promotes relaxation.

Where can I get help?

At Memory Gains, with the guidance of a psychologist we can sort out what is causing your attentional difficulties and work on these issues simultaneously. The good news is when you see gains in one area (reduction in depression, improvement of ADHD symptoms) you may notice improvement in other areas as well! We offer free 15-minute consultations and can tailor a specific treatment plan that meets your needs. Let’s get your life on track!

Sahra Kim Psy.D.

Email: kim@memory-gains.com

Phone: 617-249-4784

*serving Massachusetts residents only

Sleeping Problems Solutions

Thu, 25 Apr 2024 19:23:00 GMT

How many times have you closed your eyes at bedtime and found your mind racing? You may be thinking about whether you paid your electricity bill, something weird you may have unintentionally said to your friend earlier, your sister recovering from surgery, and all the stuff you must do the next day. You can shut your eyes, but cannot shut off your mind.

What are the consequences of poor sleep?

What do you do in bed other than sleep? Perhaps you’re perusing in your laptop while in bed or finishing up checking on some emails you missed during the day. You may be on your phone scrolling through Facebook or watching the news coverage on television.

Although all these things seem harmless, they all contribute to sleep problems.

One of the main reasons is you have learned to associate your bed with everything other than sleep. These other things stimulate you and increase your arousal, keeping you awake. The news coverage may make you worried about the state of the world. That email you just checked reminded you of all the deadlines from work, and social media in general can be more stressful than not – of course unless you’re only watching videos of puppies in bed.

All these things are stressful - all this stress and worry continues even when you are trying to sleep. You have conditioned yourself to make the bed a place where you think and worry rather than sleep. One of the main things you can do is retrain your brain to see your bed as a place of relaxation and sleep.

If you need guidance of how to improve not only the quantity but quality of sleep, Cognitive Behavioral Therapy for insomnia (CBT-i) is a gold standard for sleep treatment. They have similar effectiveness as medications, but the long-term effects are even greater. Memory Gains PLLC can provide you with the tools to help you get the sleep you want.

Understanding When It's Time to Consider a Neuropsychological Evaluation for ADHD

Mon, 22 Apr 2024 17:13:00 GMT

Navigating the world of mental health can sometimes feel like a complex maze. If you've been experiencing symptoms that could be indicative of Attention-Deficit/Hyperactivity Disorder (ADHD), such as persistent challenges with organization, time management, focus, and difficulties starting and completing tasks, you might find yourself wondering if a neuropsychological evaluation is the right step forward. As a neuropsychologist, I'm here to help you understand when such an evaluation might be beneficial and how it could potentially enhance your treatment journey.

ADHD is a neurodevelopmental disorder that can significantly impact various facets of your life, including your ability to focus, control impulses, and stay organized. Diagnosing ADHD isn't always a straightforward process, as its symptoms can often overlap with other conditions. This is where a neuropsychological evaluation can provide much-needed clarity.

When Should You Consider an Evaluation?

Uncertain Diagnosis: If you're grappling with symptoms that could be related to ADHD, but you also have other conditions like anxiety or depression, it can be challenging to identify the primary cause of your struggles. A neuropsychological evaluation can help clarify your diagnosis.

Limited Progress: If your symptoms persist or worsen despite ongoing therapy, it might be time to consider a neuropsychological evaluation. This could suggest that ADHD, rather than another mental health condition, is the main issue.

Daily Life Impact: If ADHD symptoms are significantly affecting your academic, occupational, or social life, a comprehensive evaluation can provide a clearer understanding of your cognitive strengths and weaknesses.

What Are the Benefits of a Neuropsychological Evaluation?

Comprehensive Insight: This evaluation offers a detailed understanding of your cognitive, emotional, and behavioral functioning. It can help distinguish ADHD from other conditions, identify any co-existing conditions, and highlight your unique cognitive profile.

Personalized Treatment Plan: The results of the evaluation can guide the development of a more targeted treatment plan. By understanding your specific cognitive strengths and weaknesses, interventions can be tailored to your needs, potentially leading to more effective outcomes.

M edication Guidance: If medication is part of your treatment plan, the evaluation can provide valuable information to guide medication management. It can help determine whether medication is effective, needs adjusting, or if alternative treatments should be considered.

Accommodation Support: The evaluation can provide the necessary documentation for academic or workplace accommodations, helping you to function more effectively in these environments.

If you suspect that you or someone you know may have ADHD, I encourage you to seek a comprehensive neuropsychological evaluation from a qualified professional specializing in ADHD. In my private practice, I offer specialized ADHD evaluations tailored to the unique needs of each individual. Through a thorough assessment of cognitive functioning, attentional abilities, and emotion regulation, I am to provide a comprehensive understanding of ADHD symptoms and their impact on daily life. With the insights gained from the evaluation, I work collaboratively with clients to develop personalized treatment plans. These plans may include individual psychotherapy, cognitive-behavioral strategies, executive functioning coaching, and recommendations for accommodations or medication management when appropriate.

If you would like to learn more about ADHD evaluations in my private practice or schedule an appointment, please visit my website . Together, we can work towards gaining a deeper understanding of your symptoms, fostering self-empowerment, and enhancing overall well-being.

Madison White, Psy.D.

Licensed Clinical Psychologist

MSW Psychological Associates

www.drmadisonwhite.com

Email: admin@mswpsychassociates.org

Phone: 508-603-6424

Don’t Follow your Gut

Sat, 16 Mar 2024 15:49:00 GMT

They say, “follow your gut.” I respectfully disagree.

Every emotion has a function. In other words, the emotion you feel tells you something about the situation. When your friend talks behind your back – you may feel anger. When you trip and fall in front of a group of people – you may feel embarrassment. When you find out Leonardo Di Caprio doesn’t make it in the Titanic - you may feel sadness.

All these emotions are valid, natural reactions to experiences. Never be ashamed of your natural reaction.

The physical sensations that co-occur with a certain emotion may include that “gut feeling.”

Emotions have a primitive function – survival. Emotions are innate to humans because it aids with survival. If you saw a bear 10 feet in front of you, that “gut feeling” or physical sensation signals to you that it may be a good idea to escape to greater your chance of survival.

What are the physical sensations when you are on the peak of a rollercoaster?

It may include increase heart rate, shallowed breathing, a feeling of a pit in your stomach, sweating, pain in your chest, and perhaps a “gut feeling”…

The physical sensations you feel when you see a bear and when you are on top of the rollercoaster are somewhat similar to each other. It is our brains that labels seeing the bear as “fear” and being in a rollercoaster as “excitement.”

Relying on that “gut feeling” alone can lead you astray. They tell you something important, but it is ultimately your brain that assess the situation to inform you whether a situation is actually dangerous or not . These physical sensations are an alert system designed to keep you alive, but it is your brain that assesses the situation. Your brain tells you rollercoasters as not dangerous.

So pay attention to your emotions, but ALWAYS follow your brain.

What is Successful Therapy?

Sun, 18 Feb 2024 14:57:00 GMT

3 things to consider for successful therapy.

Not all therapy is the same.

What does therapy look like? When I ask people who have never been to therapy before this question, they tell me they picture themselves lying on a reclining chair, rambling about whatever comes to mind or “free associating” with the psychologist out of view behind them, jotting down notes. Although that chair seems extremely comfortable, oftentimes therapy sessions don’t look like this. In fact, therapy can be challenging and even uncomfortable.

Therapy is about changing a mindset - a pattern you’ve had for years and finally realizing that it is not adaptive anymore. Therapy is deciding that it’s time for a change.

“A comfort zone is a beautiful place but Nothing ever grows there.”

There are 3 crucial components that make therapy successful.

1. Relates to the client and psychologist -One of the most important things is having a good psychologist and client relationship. What is “good?” For many, it means having “good” rapport. Client needs to feel they can trust the therapist, and feel like they are not judged, but rather understood. Honest conversations are important, but it is done with empathy and respect. It is this relationship with your psychologist that is foundational in therapy. If clients feel that they cannot connect with the psychologist (after some effort) it might be time to find one they can.

2. Relates to the psychologist - Therapy is not just about passing time, and talking about your day. It may involve some small talk as this is necessary to build rapport, but therapy should have concrete, realistic, and specific goals. Psychologists are not viewed as friends; they are not connected to their clients’ social world and therefore can provide objective perspectives and limited bias. Importantly, psychologists should be trained and experts in an evidence-based therapeutic modality. Evidenced-based therapy includes Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, etc. “Evidenced-based” essentially means the research supports this type of treatment. CBT, a type of therapy that identifies maladaptive thought patterns for example, has been tested in several empirical studies and has been proven to help and improve the mood of those suffering from depression and anxiety among other mental health conditions. Although anecdotal information like your neighbor saying this herb can “cure” your PTSD may be helpful for some, I recommend people approach “cures” that have not been extensively studied with caution, and always have some healthy skepticism. What research tells you is out of hundreds of people who have attempted this specific treatment, a great deal of them saw improvement.

3. Relates to the client - The client needs to be motivated to change. Oftentimes, psychologists see people dragged into office by their parents, spouse, friend, etc. but these people may not necessarily be aware that there is a problem. Change cannot happen without awareness, but it goes a step further than that. Change cannot happen if there is no motivation. Clients need to put in the work to see change. This means not only actively learning the skills in therapy, but also applying and making an effort to utilize them in their day-to-day lives. Having depression can certainly make it even more challenging to be motivated, but that is what the psychologist is there for - to help gain insight and provide support to make a meaningful difference in their lives.

The American Dream

Mon, 05 Feb 2024 22:59:00 GMT

My grandparents raised me since I was in middle school. My grandfather ran a strict household where diligence and perseverance were highly valued. He was a South Korean Marine who earned rank as a Colonel, and fought along side American soldiers in the Korean War. After his service, he traveled to Oklahoma to learn about new artillery, and earned a certificate, which still hangs in my childhood home. He told me the minute he stepped onto American soil, he knew that he wanted become an American citizen. He knew that it would be the beginning of a tough and arduous journey, but America was a symbol of hope. He taught me the importance of hard work and a good work ethic, which are qualities I continue to carry today.

When I was younger, I was struggling to choose my career path and sought advice from my grandfather. With no hesitation, he said, “be a medical doctor.” He said that in times of war, there are very few survivors; those who are spared are those who have the skills to save others. He encouraged both my twin sister and I to become doctors. Throughout college, my goal was to “be somebody who can save people.” I majored in Biology in hopes of one day going to medical school, but I learn very quickly that I did not enjoy it. I still wanted to save people, but it clearly was not going to be in the same path that my sister ultimately chose. Remembering a Psychology class that I enjoyed in high school, I switched my major to Psychology in college. I finally found something I was very excited about . After college, I knew I wanted to pursue graduate work in Psychology and began in a Master’s program in Clinical Psychology at Pepperdine University. After completing the Master’s degree, I wanted to go deeper into the field that I loved and began the doctoral program at Loma Linda University. Initially, when I began graduate work in Psychology, I had the same goal of “saving others.” However, throughout my education and experiences, one of the biggest lessons that I have learned is that the ultimate goal is not for me to save others. The ultimate goal is to teach others to save themselves . I learned that our work as psychologists is to help people understand the extraordinariness of the human spirit and to realize that even under the most difficult of circumstances, people have the inner resilience and the strength to continue on. This is the true definition of a survivor. Psychologists have a special role in not only educating people about the skills in evidence-based treatments, but also giving them hope that they can manage their symptoms. It is the same feeling of hope that my grandfather came to see when he came to America for the first time.