One of the most complicated disease processes is dementia. Dementia, which is now referred to as major neurocognitive disorder, is done so and labeled in such a way because it is a dysfunction of multiple cognitive domains, the most salient being memory. That is most concerning to a patient and their family. When memory deficits occur, that has a tendency to play a very important role in many peoples’ lives because it really hinders or really challenges their ability to live independently and function to their fullest.
With neurocognitive testing in conjunction with functional imaging and structural MRI, which is the MRI that most people are familiar with, when you see this neurodegenerative pattern across time you tend to think this must be progressive. Is this Alzheimer's type dementia? Is it major neurocognitive disorder? Is this vascular dementia that is typically due to stroke and something that happens to be more reversible?
With structural imaging, new modern techniques have a tendency have to pick up on plaques or calcium deposits that are in the brain. This is linked to Alzheimer's disease or a tendency to progress into Alzheimer's disease. The plaques are not reversible. This calcification is a process that's done over time. There's a myriad of reasons why this can occur.
Most typically it is genetic. Other times it is more force- or impact-based. This is where neuropsych is very important because we have serial testing for our patients. A huge population of my patients are those with TBI, traumatic brain injury. Traumatic brain injury is also referred to as a concussion. That is what most people kind of equate it with.
Through my career, seeing many, many high school and college athletes, repeated head injuries have a tendency to cause prolonged neurocognitive difficulties that may result in plaques or a hardening. Think of scar tissue in terms of concussions. The older you get, this scar tissue interferes with everyday healthy functions. That has a tendency to be seen on imaging as a person gets older.
