Lecanemab: Getting an Alzheimer's diagnosis (Part 2 of 3-part series)

Part 2: Am I eligible to take lecanemab? How can a neuropsychologist help to answer this question?

Lecanemab is effective in people with mild cognitive impairment and with early dementia caused by Alzheimer’s disease.

Investments in training over the last two decades have increased the capacity of general practitioners in Quebec to diagnose and treat dementia. However, it can be difficult to distinguish between normal age-related cognitive changes and the earliest stages of dementia, i.e., minor neurocognitive impairment or MCI. Furthermore, cognitive decline can be caused by brain disorders other than Alzheimer’s disease. For these reasons, patients are sometimes referred to memory clinics where they are assessed by a team specialized in diagnosing neurocognitive disorders.

Neuropsychologists often contribute to the diagnostic process, by giving tests that measure an individual’s memory functioning in the context of their other cognitive functions. These cognitive domains typically include attention, visual and verbal information processing, judgment and reasoning, and other abilities that help us work toward a goal.

Neuropsychologists interpret the pattern of strengths and weaknesses across different tests to make conclusions about the nature and the severity of cognitive impairment. This information is used for diagnosing and staging the severity of a neurocognitive disorder.

The neuropsychological assessment answers the question: Is my memory worse than that of other people my age or is this normal for my age?

A neuropsychologist also considers symptoms such as anxiety or depressed mood that can interfere with cognitive functioning.

In cases of mild memory issues, it can be helpful to have a follow-up assessment to know if cognitive problems are getting worse, before concluding that a patient is on a path toward dementia.

The wait list for memory clinics in the public health system can be lengthy in Quebec, as in most of Canada. Private clinics can be a costly but time-saving alternative. For various reasons, some people opt to have a neuropsychological assessment in the private sector. For example, they may notice changes in their cognitive abilities while still functioning in their various life roles. They want to know if there is any early evidence of abnormal memory decline, which may not show up on screening in a routine visit to their doctor. In later mid-life, some people choose to see a private neuropsychologist because they have a high genetic risk for Alzheimer’s, or other health-related risk factors. They want to establish a “baseline” of their memory and other cognitive abilities before they notice any substantial changes.

After testing is complete, the neuropsychologist explains the results and offers recommendations for future follow-up. They also offer individualized recommendations based on the results of the assessment. These may include strategies for managing cognitive problems, referrals to other professionals, and links to resources for additional support.

In conclusion, a neuropsychological assessment can help determine your eligibility for treatment with drugs that target Alzheimer’s disease.

At the NeuropsyKoski clinic, two types of assessment are offered:

1.     Screening for cognitive impairment: This is a 2-hour visit consisting of a background interview, a brief battery of cognitive tests, and immediate feedback on the results.

2.     Comprehensive neuropsychological assessment: This takes place over 2-3 visits, allowing for more in-depth assessment of specific cognitive problems, questionnaires and/or interviews with family or other informants, and more personalized recommendations based on the results.

For a 15-minute phone consult with Dr. Lisa Koski to discuss your needs and make an appointment:

Call 514-601-6076

OR

Send an email to lisa@neuropsykoski.com with your contact info and best times to call 

Coming up in my next blog....

Part 3: What else do I need to know about eligibility and availability of lecanemab?