Understanding Dementia from a Psychological Perspective

Dementia is a progressive brain disease that affects memory, thinking, and behavior. As we age, our brains naturally undergo changes, but dementia is a more severe condition that can significantly impact our daily lives. Many people worry about normal age-related brain changes, like slightly slower processing speed or periodic forgetfulness, but these are often nothing to worry about, and they are not dementia. Dementia involves brain changes that interfere with a person’s ability to do life tasks, such as managing money, managing medication, remembering important appointments, safely cooking, or navigating a new route. Here’s a little information about dementia in older adults that might help if you are trying to learn more.

Types of Dementia

While there are many forms of dementia, the most common include:

• Alzheimer's Disease: This is the most common type of dementia, characterized by the gradual loss of brain cells. It typically begins with memory loss, but as the disease progresses, it can affect language, thinking, and behavior.

• Vascular Dementia: Caused by damage to blood vessels in the brain, vascular dementia can lead to sudden cognitive changes a gradual decline that pauses and restarts due to a buildup of damage in the brain.

• Lewy Body Dementia: This type of dementia is characterized by the buildup of abnormal protein deposits in the brain. Symptoms can include hallucinations, sleep disturbances, and motor problems, in addition to memory loss and other problems.

• Frontotemporal Dementia: This condition affects the frontal and temporal lobes of the brain, leading to changes in personality, behavior, and language.

Common Symptoms of Dementia

The symptoms of dementia can vary depending on the type of disease and the stage of progression. Some common symptoms include:

• Memory loss, especially short-term memory

• Difficulty following conversations or completing familiar tasks

• Changes in mood or personality

• Challenges with language and communication

• Disorientation and confusion

• Problems with spatial awareness

• Wandering or getting lost

• Changes in sleep patterns

Supporting Older Adults with Dementia

Caring for an older adult with dementia can be both challenging and rewarding. Here are some tips for supporting individuals with this condition:

• Create a Safe Environment: Ensure that the home is safe and free of hazards to prevent accidents. Do your best to cut down clutter and eliminate the need for stairs. Consider installing safety features such as grab bars and ramps.

• Maintain a Routine: A consistent daily routine can help individuals with dementia feel more secure and less confused. In fact, people with dementia are often able to be quite independent if they have a set and predictable routine. Dementia often suddenly worsens when people have an unexpected change in routine, for example, after a fall or illness that requires hospitalization. This is because a brain with dementia cannot “bounce back” from change the way it could before, so people often have a marked decline around changes.

• Provide Socialization: Encourage social activities and interactions with loved ones to help maintain a sense of connection.

• Consider Professional Care: As the disease progresses, it may become necessary to seek professional care, such as assisted living or home health services. I always advise families to start looking before you think you will need this type of help, because waitlists can be long, and finding a good fit can take time.

• Seek Support: Connect with support groups or online communities for caregivers of individuals with dementia. Sharing experiences and advice can be helpful.

Coping with Dementia

Coping with dementia can be emotionally challenging for both the individual and their caregivers. It is important to remember that there is no cure for dementia, but with the right support, it is possible to maintain a good quality of life, often for a long time. Some strategies for coping include:

• Accepting the Diagnosis: Acknowledging the diagnosis and understanding the disease can help reduce stress and anxiety. Talking about the situation and feelings with loved ones can help everyone feel supported.

• Seeking Counseling: Talking to a therapist can provide emotional support and coping strategies. This can be especially helpful early on in a dementia diagnosis, when a person is very aware of their diagnosis and what it means and may experience fears, grief, and anger.

• Caregiver Self-Care: It is essential for caregivers to prioritize their own well-being. Make time for self-care activities, time away from caregiving, and rest. This is often the most difficult part of caregiving, and caregivers often feel they have to “give up” their own lives in order to support their loved one with dementia. But self-care is incredibly important, because none of us can give from an empty cup, and caregiver burnout is common.

• Focusing on Positive Moments: Celebrate small victories and cherish the time spent together. Identify the activities that still bring joy and are doable, and focus on those, rather than what you can no longer do. For example, reading a favorite book out loud together, looking at pictures of your life, or going on walks outside together are simple things that people with dementia often enjoy well into the disease progression.

Dementia is a complex disease that affects millions of people worldwide. It can feel like a devastating loss that drags on for years and is hard on the individual with dementia as well as their families and friends. Understanding what is going on is the first step in coping and finding the best quality of life possible with dementia.

Begin Dementia Testing in Los Angeles, CA

You and your loved ones don’t have to wonder if dementia is playing a part in your health concerns. Dr. Reger is happy to offer support with dementia testing and other forms of support to help you achieve greater clarity and understanding. You can start the assessment process by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start having your questions answered!

Other Services Offered by Dr. Reger in Los Angeles, CA

Dementia testing isn’t the only service offered at my Redondo Beach-based practice. In addition, I am happy to also offer capacity assessments, neuropsychological and psychological assessments, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more help today!

The Challenges of Testamentary Capacity: A Guide for Families

If you’re concerned about a loved one's ability to make a will, you're not alone. Determining testamentary capacity – the mental ability to create a legal will – can be a complex and emotionally charged process. In my experience conducting capacity assessments for over a decade, here are some of the most common challenges patients and their families face.

What Does Testamentary Capacity Mean?

In California, the law defines testamentary capacity as the ability to understand the nature of a will, the extent of one’s property, and the “natural objects” of one’s bounty. Simply put, testamentary capacity is the ability to understand what a will is, know what property you own, and understand who your loved ones are. It might sound straightforward, but determining if someone has this capacity can be challenging in some cases.

The Challenges You Might Face

Uncertainty about your loved one’s mental state:

It can be difficult to tell if changes in your loved one's behavior are normal aging or signs of something more serious. This is especially concerning if there is suspicion of “undue influence,” which means that someone is deliberately trying to coerce an older adult or otherwise vulnerable adult to change their will. 

Disagreements within the family:

Family dynamics can become strained when there are questions about someone's mental capacity, particularly when there is money or property that will be distributed. I have worked with many people who are shocked at the way their family members have behaved when there is money at stake and a question about their loved one’s capacity to make decisions about their estate. Navigating these dynamics is often the most painful aspect of capacity cases.

Complex legal process:

Navigating the legal system can be overwhelming, especially when dealing with sensitive family matters. I always recommend having an attorney with expertise in elder law and estate law involved in capacity cases, because the advice of medical providers or a psychologist, such as myself, is no replacement for knowledgeable legal guidance.

Emotional toll:

The process of assessing testamentary capacity can be emotionally draining for both the individual and their family. Even in the most straightforward cases where capacity testing is just to demonstrate that things are fine and a person has the capacity to make a change to their estate, the assessment involves some amount of cognitive testing, interviews with the patient and family or caregivers, and often a review of medical and/or financial records. This takes time and energy and involves talking about sensitive things. In more complex cases, the time and energy required will be more extensive.

What to Do If You Have Concerns

If you're worried about your loved one's ability to make a will, it's important to seek professional help. A qualified psychologist who specializes in capacity assessment, like myself, can conduct a comprehensive evaluation.

Open communication:

Talk to your loved one about your concerns in a respectful and supportive manner.

Gather information:

Collect any relevant medical records, legal documents, financial records, and observations of your loved one's behavior. For example, sometimes a person’s bank statements show evidence of concerning decisions, such as a pattern of donating thousands of dollars to questionable causes, or months of late fees because they are not paying bills on time. If you suspect a loved one may need a capacity assessment in the future, I highly recommend keeping a log of your observations, with dates, so that you can easily recall and report these incidents to the psychologist doing the testing.

Seek legal advice:

Consult with an attorney to understand the legal process and your rights. Ideally, this should be an attorney with relevant expertise in estate law, probate, or elder law.

Build a support system:

Reach out to family and friends for emotional support. If you are at the point where you are considering a capacity assessment, it is likely you have already experienced worry and stress related to this situation. Don’t be afraid to talk to your close friends and family about the situation, and don’t be afraid to ask for help and support.

Seek An assessment for Testamentary Capacity in Los Angeles, CA

Remember, you're not alone in facing these challenges. Many families have gone through similar experiences. By seeking professional guidance and support, you can navigate this difficult process with greater clarity and understanding. You can start the assessment process with Dr. Reger by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start having your questions answered!

OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

Capacity assessments are not the only service offered by my Redondo Beach-based practice. I’m also happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more help today!

When Neuropsych Testing Results Aren't What You Expected

Receiving neuropsychological test results can be a complex and emotional experience.

While these assessments provide valuable insights into cognitive and emotional functioning, it's not uncommon to encounter unexpected findings. Throughout more than a decade of experience in psychological and neuropsychological assessment, I have often given feedback to people who are surprised by the findings, or sometimes by what was NOT found on testing. For example, I have done psychological assessments with adults who have self-diagnosed with ADHD or autism or have been misdiagnosed by physicians without an assessment. On some occasions, the testing and overall data don’t support a diagnosis of ADHD or autism.

For many people, a mental health or cognitive diagnosis like ADHD is a big part of how they understand their own behavior and needs, and it is a huge adjustment in their self-understanding when test results aren’t what they expected. On the other hand, I have also done assessments in which someone suspected one diagnosis but received another based on testing. For example, I have diagnosed PTSD in cases where people suspected an anxiety disorder or bipolar disorder, but their symptoms actually indicate a trauma response. Unexpected neuropsych test results can be shocking and may feel devastating, as they raise many questions about how and why people were misdiagnosed before, or introduce a diagnosis that is hard to understand. Here are some thoughts about how to navigate that.

Understanding Your Results

The first step is to fully understand the results. This involves a thorough discussion with your psychologist. Don't hesitate to ask questions, seek clarification, and request additional explanations. It's essential to grasp the strengths and weaknesses highlighted in the assessment, as well as the implications for your daily life.

Remember, neuropsychological tests measure cognitive abilities in a specific context. They don't define your overall worth or intelligence. Results can be influenced by various factors, including mood, medication, and sleep patterns, and your psychologist should explain the results thoroughly.

I always tell my testing patients that they are welcome to reach out any time after a feedback session with questions. It can be overwhelming to receive testing feedback, and it’s easy to miss things when we’re overwhelmed. Never hesitate to call your psychologist to ask a question, even if you’ve already had feedback.

Processing Your Emotions

It's natural to experience a range of emotions when confronted with unexpected results. You might feel shock, disappointment, anger, or even relief. Allow yourself to process these feelings without judgment. Talking to a trusted friend, family member, or therapist can provide emotional support and help you make sense of your experiences. Please know that whatever you feel is ok, and it takes time to adjust to new information that may have a wide impact on your life.

Seeking Additional Perspectives

While your psychologist is the primary interpreter of your results, seeking input from other professionals can offer valuable perspectives. Consider consulting with a neurologist or a specialist in your specific area of concern. They can provide additional insights and potentially suggest alternative explanations for the findings. If this is recommended, usually your psychologist should let you know at the feedback session, and make this a written recommendation in your report, so you won’t forget.  Other common recommendations for consultation after testing include psychiatry and perhaps a therapist for a specific emotional concern.

Developing a Coping Strategy

Once you have a clearer understanding of your results, it's time to develop a coping strategy. This involves identifying specific challenges and exploring potential solutions. For example, if memory difficulties are identified, you might consider using organizational tools, seeking support groups, or exploring memory enhancement techniques. Your psychologist can usually recommend options that fit your needs.

Setting Realistic Goals

It's important to set realistic goals based on your strengths and limitations. Focus on what you can control and avoid comparing yourself to others. Celebrate small victories and acknowledge your progress, no matter how incremental it may seem.

Building a Support Network

Surrounding yourself with supportive individuals is crucial during this challenging time. Connect with family, friends, or support groups who can offer encouragement and understanding. Sharing your experiences with others who face similar challenges can also be helpful. I know many people are hesitant to seek out a support group because it can feel vulnerable, but learning from others who have dealt with the same diagnosis can be immensely beneficial, both in terms of the emotional support and the opportunity to learn practical ways others have managed.

Considering Further Evaluation

In some cases, additional testing or evaluation may be warranted. If you have concerns about the accuracy of the initial assessment or if symptoms persist, discuss these options with your psychologist.

Remember, You Are Not Alone. Seek Neuropsych testing in Los Angeles

Receiving unexpected neuropsychological results can be a daunting experience, but it's important to remember that you're not alone. Many people successfully navigate challenges related to cognitive difficulties. With time, patience, and appropriate support, you can develop strategies to cope and thrive. Dr. Reger can offer you support by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Come to a better understanding of your neuropsych results!

Other Services Offered by Dr. Reger in Los Angeles, CA

Neuropsychological and psychological assessments are not the only services offered by my Redondo Beach-based practice. Other assessments include cognitive and dementia testing, pre-surgical assessments, capacity assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more help today!

Ensuring Your Wishes Are Heard: Understanding Testamentary Capacity Assessments in California

I have been doing capacity assessments for over a decade, and even after many years of experience, each case is unique, because people have many different life experiences that come into play in these complex evaluations. I find that most people, apart from attorneys working in this area, have questions about exactly what "testamentary capacity" is, and how a psychologist such as myself, might conduct this type of assessment. In this article, I will try to clarify some common misconceptions about testamentary capacity, which is a crucial aspect of estate planning in California. Let's start with an easy one: What is meant by "testamentary?” This is simply the capacity, or ability, to create a will that decides where a person's assets, whether financial or in the form of property and possessions, are going to go after that person has passed.

California Law and Testamentary Capacity

In California, Probate Code Section 6100 states that anyone 18 or older who is "of sound mind" can make a will. "Sound mind" translates to having testamentary capacity, and this can get very tricky in situations where there is a question of a person's cognitive function or ability to make decisions. Questions about a person's "sound mind" often come up in situations of severe mental illness, such as schizophrenia, or when a person's cognitive function is impaired because of a disease process, like dementia. Here, the law defines mental competency for creating a will as having the ability to:

1. Understand the nature of the testamentary act (making a will).

2. Understand and recollect the nature and situation of their property (this includes money, real estate, possessions, and any other assets).

3. Understand the natural objects of their bounty (who they might typically leave assets, like close relatives).

Legal terminology can be overwhelming for those others who are not legal professionals, but in this case, the law simply means that a person needs to understand what it is to make a well, what property or money they have to give away, and who they might leave their assets to after their death. In some cases, this is very straightforward, and there is no question of a person's ability to make a will, know what they have to give, and know who they want to give it to. But in other situations, testamentary capacity is not straightforward at all, for example, in the case of a person with dementia who cannot understand the meaning of making a will, or in the case of a person with schizophrenia who holds a delusional belief that a family member is plotting against them, and wishes to cut that person out of their will as a result of this delusion.

California-Specific Considerations

While the core evaluation process remains similar, here are some California-specific aspects to consider:

• Presumption of Capacity: California law presumes a person has testamentary capacity unless proven otherwise. This is very important because it is a matter of respect for individual autonomy. This is something that all of us want and expect–to make our own decisions about our lives, including what we want to happen to our assets after we die.

• Undue Influence: California courts take undue influence on the testator (person making the will) seriously. A capacity assessment, like the ones I conduct, will pay close attention to potential manipulation or coercion, especially if the will significantly deviates from what the person would typically do. For example, I have seen cases in which an older adult with a dementia diagnosis wishes to change their will to leave assets to a caregiver who has become intertwined in their life recently, despite concern and suspicion from family members who believe the caregiver is asserting undue influence over the person.

Finding Help in California

California has a vast network of qualified professionals to assist with testamentary capacity assessments, including myself. Typically, either a person wishing to establish or change their will, or a concerned family member, will reach out to me with a request for a capacity evaluation to determine whether the person has the capacity to make these changes. The evaluation involves testing and interviews with the person wishing to change their will, as well as collateral interviews with family members, caregivers, and others who may have insight into this situation and the person’s history and values. These evaluations also sometimes involve looking at financial records and medical records, which may provide valuable evidence about a person's capacity. For example, if financial records show that a person has been unable to pay their bills independently, or has given away thousands of dollars recently to scams, this may be evidence to understand the person's capacity to make it well. 

Estate planning attorneys can also guide you through this process, and I often get referrals from estate planning and attorneys for testamentary capacity evaluations in California.

Remember:

• A testamentary capacity assessment conducted by a qualified psychologist in Los Angeles and throughout California strengthens your will's validity.

• Don't hesitate to seek an evaluation, especially if pre-existing health conditions might raise concerns down the road. By planning ahead, you ensure your wishes are respected and your loved ones' inheritance is protected.

Begin a Testamentary Capacity Assessment in Los Angeles, CA

I would be happy to use my years of experience in conducting capacity assessments to help you find the right path forward. You can learn more about the benefits of testing with Dr. Reger by and more by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start evaluating testamentary capacity!

Other Services Offered by Dr. Reger in Los Angeles, CA

Capacity assessments are not the only service offered by my Redondo Beach-based practice. I’m also happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more help today!