Category: News

It is no secret that depression can resemble dementia.  The question is, how can we differentiate the two?

Dementia and depression share common features.  Researchers have found that people who become depressed later in life have a 70% increased risk of developing dementia (www.health.harvard.edu).  Dementia in older adults is steadily increasing, along with emotional problems like stress and anxiety.  These emotional problems can lead to forgetfulness, confusion, and other symptoms that look like depression.  Many older adults develop memory problems from health issues, or side effects of medications, vitamin deficiencies, or even substance abuse. Cognitive issues related to these areas may be treatable.

What is dementia?  This is not a specific disease, but a group of conditions characterized by impairment of at least two cognitive brain functions like memory loss and judgment.  A few types of dementia include Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia.

Symptoms of dementia include memory loss that affects daily functioning, difficulty planning and problem-solving, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images, problems with words in speaking or writing, poor judgment, withdrawal from social activities, and changes in mood or personality.

If it is depression, a behavioral health issue is causing the person to feel continued sadness.  They lose interest in everyday things.  Depression is one of the most treatable mental health disorders.  Seeking help can significantly improve a person’s life.  Some depression signs and symptoms are:  Trouble concentrating, remembering detail, persistent fatigue, feelings of worthlessness, hopelessness, irritability, and suicidal thoughts.  If it is depression, getting treatment can improve memory, concentration, and energy.  Eating healthy, getting enough sleep, staying active, being socially engaged, exercise, and controlling stress levels are all important to one’s emotional health.

Depression vs. Dementia

A person with depression will likely recognize if they are having memory problems, whereas someone with dementia may be less likely to notice the decline. Depression, confusion, or forgetfulness can come on suddenly, whereas dementia typically causes a slow cognitive decline.  People who are depressed know who they are speaking with, what day and time it is, and where they are.  People with dementia are impaired in these matters.  Depressed people use language correctly, though they may speak slowly at times.  However, someone with dementia has many language issues such as difficulty remembering someone’s name or the name of certain objects.

Both depression and dementia are unique to the individual and vary case by case.  Whether memory loss or cognitive decline is caused by depression or dementia it’s important to seek a medical workup first and then see a neuropsychologist who will administer a neuropsychological examination, who will then be able to list the thinking problems and behavioral changes and make the case whether it’s dementia vs. depression.

For more helpful tips on how you can help your loved ones who are dealing with dementia or depression, give us a call for a consult and put the question to rest.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal, Director of Training

According to the International Dyslexia Association, “Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

The role of Neuropsychology is to provide comprehensive evaluations via objective testing, to assess a person’s reading and writing abilities in the context of general neurocognitive functioning. In addition, the data via the Neuropsychological Examination provides information about brain-behavior functioning and cortical functioning involved in reading and writing conditions, such as dyslexia.

A pivotal article published in 2008, titled, “Learning disabilities: The need for neuropsychological evaluation” from Archives of Clinical Neuropsychology, reads the following, “A learning disability (LD) is a neurobiological disorder that presents as a serious difficulty with reading, arithmetic, and/or written expression that is unexpected, given the individual’s intellectual ability. A learning disability is not an emotional disorder nor is it caused by an emotional disorder. If inadequately or improperly evaluated, a learning disability has the potential to impact an individual’s functioning adversely and produce functional impairment in multiple life domains. When a learning disability is suspected, an evaluation of neuropsychological abilities is necessary to determine the source of the difficulty as well as the areas of neurocognitive strength that can serve as a foundation for compensatory strategies and treatment options.”

Here at NRS|LS, we are here to help you or your child assess for learning disability and provide comprehensive treatment and recommendations.

If you have any questions, please feel free to contact our office.

ADHD requires a multi-factorial treatment approach.

Besides the traditional neuropsychological approach consisting of consultation, neuropsychological examination, treatment (Medical Adjustment Counseling), and Cognitive Rehabilitation, the following are supplemental approaches:

Diet:

• Individuals with ADHD can be more sensitive to certain foods, meaning their symptoms worsen from consuming them.
• Foods with artificial additives, preservatives, and colors can increase ADHD symptoms.
• Sugar is a common additive in foods that increases the hyperactivity in those with ADHD.

Exercise:

• Physical exercise can be effective in reducing ADHD symptoms (inattention, impulsivity, &hyperactivity)

Supplements:

• Vitamins/Minerals (see your nutritionist for specifics)

Sleep:

• Not getting proper sleep can worsen ADHD symptoms
• Sleeping Disorder (Comorbidity)
• Difficulties falling asleep (sleep onset), awakening at night, low sleep duration

Neurofeedback/Biofeedback:

• Helps individuals control and understand their own behaviors
• Looks at brain waves to retrain the brain
• Individuals are taught to self regulate brain activity
• Neurofeedback therapy, alongside other services, has been found to improve ADHD symptoms

Aerobic Exercise:

• Walking, running, cycling, jumping, swimming, dancing (10-30 minutes daily)

Yoga

• Less intense form of exercise – physical postures, breathing exercises, deep relaxation, & mindfulness/meditation

Psychotherapy:

• Individual therapy
• Group therapy
• Family therapy
• Executive functioning building

Meditation/Mindfulness:

• Meditation and mindfulness can improve focus, concentration, behavioral issues, self-control, and sleep quality

Strength-Based Approach:

• Focuses on the individual’s strengths, success, and resources
• Pays less attention to the challenges faces by those who have ADHD
• This approach can be implements at home and in the school setting

Sleep Schedules:

• Having proper sleep schedule can help with troubles, falling asleep, and staying asleep

Please call our office for further information.

Michelle Blose, PsyD
Neuropsychology Post-Doctoral Fellow

HRV biofeedback is a unique service offered at NRS|Lifespan. While some patients seek out this treatment intentionally, others are referred for biofeedback by their medical doctors and, therefore, have little knowledge about this treatment and how it may be useful to them. Here are some FAQs about HRV biofeedback to provide some brief background:

(1)   What is biofeedback?

Biofeedback is a tool that clinicians use to gain real-time metrics about an individual’s emotional and physiological status, similar to how a thermometer reads your body’s temperature at any given moment. In essence, it forges a connection between what you consciously think and feel in the moment and how your body is responding to it “under the surface”. Usually the major goals of biofeedback include building awareness into the mind-body relationship and then learning which coping mechanisms actually change your mental state and body for the better.

(2)   What is Heart Rate Variability (HRV)?

HRV is one type of metric that is an extremely useful global indicator of health, physical and emotional. It captures level of physical conditioning, balance between the sympathetic and parasympathetic nervous system, reactivity to stress and the body’s ability to recover from stress with respect to cardiovascular and immune system functioning. High HRV levels are correlated with lower levels of disease, depression, anxiety, and stress-influenced symptoms while low levels of HRV reflect the opposite – greater cardiovascular and autoimmune risks as well as higher levels of depression, anxiety, stress reactivity, and cognitive complaints (e.g., brain fog, short-term memory).

(3)   What types of issues does HRV biofeedback target?

Some of the positive effects of HRV training include: lowered heart rate, blood pressure and blood lipid panel; reduced inflammatory markers; increased pain tolerance; reduced cortisol levels; increased sense of well-being and sleep quality; reduced symptoms of depression and anxiety; better focus and ability to screen out distractions; improved executive functioning skills; and better clarity in thinking accompanied by creativity. Therefore, individuals with stress-driven physical, emotional, and cognitive complaints are good candidates for HRV biofeedback.

(4)   What does a typical course of HRV biofeedback look like?

In an outpatient setting, HRV biofeedback is intended to be a short-term treatment (6-10 sessions on average) that focuses on patient education, increasing awareness into the mind-body relationship, acquisition of skills, and application to everyday life. Clinicians customize the plan of care based on a patient’s medical and emotional complaints. This program is designed to be collaborative and highly dependent upon the motivation and participation of the individual. Therefore, its course and completion date are based on the patient’s goals, baseline status, and biofeedback metrics showing that HRV is trending in a positive direction.

(5)   How do I schedule a consultation appointment to learn more?

Call our main office number, 732-988-3441, to schedule a consultation appointment with our staff clinical health psychologist to find out if you could benefit from HRV biofeedback.

• Neurodivergent describes people whose brain differences affect how their brain works
• The word “Neurodivergent” is not a medical term. It exists as a way to describe people using words other than “normal” and “abnormal”
• Some Neurodivergent people struggle because of systems or processes that limits their abilities to demonstrate their strengths or that create new or more intense challenges for them
• For someone who is Neurodivergent, an accommodation is a way to accept that they are different or have challenges, and give them skills to succeed

• Common conditions of those who are described as Neurodivergent:
  • Autism Spectrum Disorder (ASD)
  • Attention-Deficit Hyperactivity Disorder (ADHD)
  • Down Syndrome
  • Dyslexia
  • Sensory Processing Disorders
  • Tourette Syndrome

Here at NRS|LS, our Pediatric Section is trained to address Neurodivergence in a subjective and objective manner, via Neuropsychological Examination and Treatment.

Please call our office for further information.

Steven P. Greco, PhD, ABN
Board Certified, Neuropsychology

Major depressive disorder (MDD) is a common mental condition experienced by millions of people. Based on National Institute of Mental Health research, more than 17 million adults in the U.S. experienced a major depressive episode the previous year.  While most people can manage depressive symptoms on their own, unfortunately some depression leads to severe impairments, affecting the ability to manage daily life. This warrants immediate attention due to increased risk for suicide. It is important, therefore, to recognize depressive symptoms/ suicide warning signs and seek professional help.

During major depressive episodes, symptoms occur most of the day, nearly every day for a period of two weeks.

Common Depressive Symptoms:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Irritability/anger, frustration
• Loss of interest/pleasure in activities once enjoyed
• Sleep problems (sleeping too much or not enough)
• Lack of energy
• Reduced appetite (weight loss) or increased food cravings (weight gain)
• Anxiety, agitation or restlessness
• Trouble thinking, concentrating, making decisions and remembering things
• Feelings of worthlessness or guilt
• Frequent/recurrent thoughts of death, suicidal thoughts or attempts

Common Suicide Warning Signs:

• Talking about suicide/making statements such as “I’m going to kill myself” or “I wish I were dead”
• Obtaining means to commit suicide (e.g., purchasing a gun, stockpiling pills)
• Withdrawing socially
• Being constantly preoccupation with death
• Feeling hopeless/trapped in a situation
• Engaging in risky behaviors (driving recklessly, using drugs)
• Giving away belongings/getting affairs in order without rational reason
• Saying goodbye to people as if seeing them for the last time
• Experiencing shifts in personality (being severely anxious, agitated)

If you have depression and you’re struggling to cope, help is available. Here at NRS|LS we provide effective treatments for depression like cognitive behavioral therapy (CBT) and Biofeedback. We can teach you skills to effectively cope with your depression and restore your ability to function in your daily life.

If you or someone you know is struggling with symptoms of depression, please call our office for a consultation.

If you or someone you know is in crisis:

• Call 911 in an emergency
• Contact Suicide and Crisis Lifeline: In U.S., call or text 988 to reach the 988  Suicide & Crisis Lifeline 24 hrs./day, 7 days/week
• The Suicide & Crisis Lifeline in the U.S.-Spanish speaking: 1(888) 628-9454

Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03

• Social Pragmatic Communication Disorder is a disorder in understanding pragmatic aspects of language.
• SPCD is characterized by reduced verbal and nonverbal communication abilities that cannot be explained by low cognitive ability, whereas ASD includes communication problems, but also has restricted, repetitive behaviors (RRB’s).
• Communication problems in SPCD can include inability to communicate appropriately in different social contexts, inability to change communication to match context, difficulty following conversational rules, and difficulty understanding what is not specifically stated (DSM-5).
• RRB’s in ASD can include repetitive motor movements or use of speech or objects, inflexible adherence to routines, and highly fixated interests (DSM-5).
• One reason that SPCD became a diagnosis was to encompass individuals affected by language and communication difficulties that did not fall within the range of typical Specific Language Impairments (Amoretti 2021).
• One study led to implications that children with SPCD may diverge more in comprehension than children with ASD (Svindt, Suranyi 2021).
• ASD must first be ruled out for SPCD to be diagnosed and therefore they cannot cooccur.
• A study conducted by Ward et al. (2020) found that 19 of their participants met the criteria for an SPCD diagnosis, but 18 of those also met the criteria for an ASD diagnosis, so therefore SPCD was ruled out for the 18 participants.
• Weismer et al. (2021) found that children that likely had SPCD reported lower levels of RRB’s than children with ASD.
• A study comparing prevalence’s of DSM-IV and DSM-5 disorders found that children diagnosed with DSM-IV Autistic Disorder, Asperger Disorder, and Pervasive Developmental Disorder had 99%, 92%, and 63% DSM-5 ASD prevalence’s respectively whereas only 1%, 8%, and 32%, respectively, met criteria for a DSM-5 SPCD diagnosis (Kim et al. 2014).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Amoretti, M. Christina; Lalumera, Elisabetta & Serpico, Davide. (2021). The DSM‑5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosphy of the Life Sciences 43(4).

Kim, Young Shin, et al. (2014).  A comparison of DSM-IV PDD and DSM-5 ASD prevalence in an epidemiologic sample.  J Am Acad Child Adolescent Psychiatry 53(5).

Svindt, Veronika & Suranyi, Balazs. (2021). The comprehension of grammaticalized implicit meanings in SPCD and ASD children: A comparative study. International Journal of Language & Communication Disorders 56(6).

Ward, Audrey; Boan, Andrea D., Carpenter, Laura A. & Bradley, Catherine C. (2020).  Evaluating the rate of Social (Pragmatic) Communication Disorder in children at risk for Autism Spectrum Disorder. Children’s Health Care 49(4).

Weismer, Susan Ellis; Rubenstein, Eric; Wiggins, Lisa & Durkin, Maureen S. (2020).  A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits.  Journal of Autism and Developmental Disorders 51.

In the past, the major focus of neuropsychology has been largely diagnostic and primarily concerned with relationships between lesion localization and subsequent cognitive/behavioral alterations. Currently the primary issue, especially in forensic and clinical settings, is to determine an individual’s functional capacity.

An individual’s ability to be successful in activities of daily living (ADL), is vitally important during personal injury litigation.  Plaintiff and defense attorneys undoubtedly are interested in determining how an individual is functioning post-injury.  Plaintiff and defense attorneys have different roles and view assessment outcomes according to their client representation (e.g., maximize deficits; minimize deficits).  The neuropsychologist will assist the attorney referral sources, and the trier of fact in answering specific questions related to an individual’s pre and post-injury status (e.g., level of functioning).  Neuropsychological test results provide information to assist in childhood, adult, and geriatric neurocognitive and behavioral conditions, particularly when neurologic, radiologic, and laboratory data are inconclusive (e.g., MTBI, post-concussive syndrome).  Forensic neuropsychological assessment also establishes an objective baseline of function, which can be later compared with re-assessment results, that is invaluable in determining the course of cerebral dysfunction.  The contribution of a patient’s personality and mood to his or her symptoms is also estimated via formal assessment.  Furthermore, neuropsychological test data assists in predicting a patient’s short and long-term prognosis.

In summary, the purpose of a forensic neuropsychological assessment is briefly described below:

• To describe the degree of cognitive impairments and explain the reasons of their existence.
• To measure behavioral impairments that result from brain injury.
• To establish a baseline of function that allows for comparisons over time
• To provide a plan for cognitive and behavioral rehabilitation treatment.
• To guide the planning and development of remedial education or vocational rehabilitation.
• To calculate the individual’s ability to resume his/her premorbid lifestyle.
• To provide documentation for litigation concerned with the functional impact of documented or suspected brain injury on cognitive and behavioral functioning.

In legal proceedings, the neuropsychologist as expert will assist both plaintiff and defense attorneys, as well as the tier of fact, in understanding neuropsychological evidence as referenced above.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

The rapid rise of digital media use has been shown to worsen ADHD symptoms and the overall state of adolescents with ADHD. This phenomenon is called Problematic Digital Media Use (PDMU) which includes use of social media, video games, television shows, etc.

During COVID and the increased use of screen time/technology has significantly increased since the pandemic. A recent study showed children ages 8-16 who had ADHD with problematical digital media use were compared to those who did not have problematical digital media use. They compared both groups and the group with the high amount of digital media use depicted substantially worse ADHD symptoms:

• ADHD Core Symptoms – ADHD adolescents with high digital media use had a much lower ability to focus and was distracted more easily.
• Emotional Problems – ADHD adolescents with high digital media use had much higher rates of anxiety and depression disorders.
• Executive Function (EF) – ADHD adolescents with high digital media use had worse EF, which includes a lack of self-control, self-regulation, and behavioral inhibition. This leads to difficulties in daily life management.
• Parent-Child Relationships – ADHD adolescents with high digital media use had more problems such as confrontation and disobedience, which can cause strained relationships.
• Learning Motivation – ADHD adolescents with high digital media use had a lower motivation to learn, higher stress levels, and learning problems compared to the ADHD group without problematic digital media use.
• Physical Activity – ADHD adolescents with high digital media spend more time on social media and video games than doing physical activity. A decreased amount of physical activity may cause depression, anxiety, and low self-esteem.

There is a correlation between high digital technology use and ADHD and because of COVID, ADHD in adolescents only became worse as digital media became more used. It is important to reduce screen time on social media and video games to prevent this from happening. A systematic, tailored approach is recommended via the counseling process. If you would like more information regarding this strategy, please contact Dr. Steven Greco, board certified neuropsychologist.  

Shuai, L., He, S., Zheng, H. et al. Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic. Global Health 17, 48 (2021).

Has your family member or partner been having increasing difficulty with independent living skills, including paying bills, food shopping, driving, or completing daily activities such as getting dressed, bathing, or eating? These difficulties, along with memory and other thinking problems, often bring families of the individuals affected by these symptoms to a neuropsychologist. The Neuropsychological Examination (NPE) is our means of identifying whether these symptoms are due to dementia or some other condition.

If your partner or family member has been diagnosed with dementia, the neuropsychologist will explain the dementia subtype. For instance, some examples of dementia subtypes include vascular dementia, dementia due to Alzheimer’s disease, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia. All dementias are progressive, meaning that the decline in daily functioning worsens over time as the condition accelerates. The diagnosis of dementia is always stressful for families, and many are unprepared to deal with the challenges presented by this medical condition.

Our office offers Medical Adjustment Counseling® (MAC) as a treatment option for families of the patients diagnosed with dementia. MAC® is based on the results of the NPE of the patient. The unique information about the patient’s brain functioning obtained from the NPE is used by your doctor as a guide for treatment. MAC® will help the family understand the patient’s condition, develop adjustment strategies for dealing with their thinking and emotional symptoms, and prepare for the future. MAC® will also help the family acknowledge and address their own emotional issues associated with the increase in caregiving responsibilities and, as a result, improve the functioning of your family unit.

If you have any additional questions about MAC®, please call our office.