Most forms of dementia begin with memory loss but other cognitive difficulties (naming problems, getting lost) can also serve as the initial symptoms. Sometimes, behavioral symptoms are the initial prominent symptom such as the decline in personal and social conduct that is typical of fronto-temporal dementia. Usually, a person with these symptoms will initially be evaluated by a primary care physician. This typically results in sending the patient for blood tests and a brain MRI (magnetic resonance imaging) to search for reversible causes of dementia and determine if there are any visible abnormalities in the brain. The MRI may show tissue loss (atrophy), abnormal areas of tissue (known as lesions), a mass such as a brain tumor, or other types of abnormalities.
There are several advantages to a neuropsychological evaluation. First, a neuropsychologist specializes in understanding the relationship between brain functioning, thinking, emotions, and behaviors. This is important because there are psychological conditions that are common in the elderly (e.g., major depressive disorder) that can mimic a neurologically progressive dementia (e.g., Alzheimer’s disease). Thus, an expert in how psychological and neurological conditions present is very important and neuropsychology offers that level of expertise.