neuroblog

Misdiagnoses in the elderly: “late onset schizophrenia” or early dementia?

Schizophrenia is many mental health professionals’ favorite default diagnosis. And nothing is more likely to trigger the diagnosis of schizophrenia than psychosis. But psychosis is an opaque term which may refer to a whole range of heterogeneous symptomatology. Hallucinations are likely to be viewed as psychotic manifestations even when they are not auditory like in schizophrenia but visual like in Lewy Body Dementia. When hallucinations were first noted in the elderly, the notion of “late-onset schizophrenia” was introduced. But this...

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Misdiagnoses in the elderly: pseudodementia due to depression or pseudodepression due to dementia?

Distinguishing between dementia and depression in the elderly maysometimes be tricky.When memory lapses or word finding difficulties become conspicuous in an elderly individual, there is usuallylittle doubt thatan early stage of a dementing process, or at least “mild cognitive impairment” is present. Butwhat if the sympomatology is dominated by apathy, hesitations, inability to initiate behaviors, and affective flatness? The the diagnosis of “pseudodementia due to depression” is likely to be made. What not every clinician realizes, however, is that these...

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Cognitive neuroscience

The term “cognitive neuroscience” is of relatively recent coinage. Sometime in the mid- eighties, I used this term in the company of respectable molecular and sensory neuroscientists,and this was immediately met with dismissiveness bordering on derision. The very juxtaposition of “neuroscience” and “cognitive” sounded oxymoronic to the traditional mainstream neuroscientist’s ear. These were the days whena deepschism existedbetween neuroscience and psychology. neuroscientists felt that the higher-order cognitive constructs like decision making or mental flexibility were too opaque to be tractable...

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Sex differences in the brain

In our “politically correct” society any consideration of sex differences is often approached with trepidation. In neuroscience they have been frequently underemphasized and altogether ignored. Indeed, the perusal of any neuroanatomy text will leave one with the impression that human brain is perfectly androgynous, since no mention of sex differences likely to be found. But female and male brains are characterized by subtle morphological and functional differences. The differences are indeed subtle, so we are not talking about two different...

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“Mild” Traumatic Brain Injury

Traumatic Brain Injury (TBI) has been called “a silent epidemic.” While it does not have the mystique of Schizophrenia, Alzheimer’s Disease, or HIV encephalopathy, TBI is every bit as prevalent as any of the above. Most TBI cases – about 60% – are classified as “mild” and the assumption is that rapid, full recovery takes place. But it is quite common for a person, ostensibly “fully recovered” from the effects of “mild” TBI exhibits subtle – or sometimes not so...

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Memory as a figure of speech

Just as “attention” or “ADHD” have become catch-all designations in the young, “memory” is often the catch-all designation in the aged. So when an older person comes to me with concerns about “memory,” restricting my evaluation to memory tests is the last thing I will do. Instead, a broader range of cognitive functions should be surveyed. This is particularly so because some of the cognitive functions particularly susceptible to the effects of aging do not go by the names familiar...

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ADHD as a figure of speech

When someoneis referredto me with the diagnosis of ADHD, this prior diagnosis carries little to no information as far as I am concerned.Likewise, when someone asks to be evaluated “for ADHD,” the narrow diagnostic workup implicit in such a request is the last thing I am going to do.Why so? Because in many lay circles and even in some professional circles ADHD has become a catch-all designation for any cognitive difficulty, whether it truly involves attention, or memory, or decision...

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