Your Brain On... Memory Testing

Ayesha Sherzai (0:00)

How do you catch a change in the brain early, and honestly, and without scarring anyone? And what do you actually do once you know? This is Your Brain On Memory Testing.

Dean Sherzai (0:16)

One of the most remarkable moments in my clinical experience was about 15 years ago or so.

I was with a patient and with a student. We always have students, usually in academic settings. And I usually send the students to do the neuropsychological testing. And this case was very important to me because I knew this patient. I had been told by the family that something had gone awry. The family was saying that this was not the same person. We're seeing some changes. And the most important part of this is this was a person that was a professor in university, very well known, and had done remarkable work in the realm of physics. And he took pride in his cognition. And on top of that, he was not aware of any changes. The family had told me about all of this, as well as the fact that he was doing some things that were very unusual. He was changing in front of their eyes. He was much more aggressive.

He would easily be frustrated. He would forget lists of names, entire lists of names. He would have difficulty performing tasks that he should have been able to do.

And that was not him. They knew that was different. So the student went in and did the neuropsychological testing, this short one, and he did well. The patient did fairly well. I mean, when you see a score like that, you usually would say that he's within normal limits. And the student came back there, said that he did very well, but there's something off. So I went back and I did the same test, but extended it a little bit. So what we distilled out of that test was that his memory was fine. Not only was he recalling five words out of five in five minutes, he could remember ten words and recall it back. And so his memory was absolutely fine. What he was making mistakes in was these tests. You have to shift between activities. So he could do one activity. And if you write it with you through a second activity, that would throw them off. And then as far as lists, this was the most remarkable. And usually you have a family member in the room as you do as well. And when we asked him to name as many words in animals as he could in one minute, he could only name seven animals. Oh, wow. And it wasn't that the instruction wasn't clear. It was very clear. I actually made sure that I was redundant as far as what I meant by animals and categories and all of that. And he couldn't and he was getting frustrated. Then we said, can you name as many words that start with the letter F? And again, only eight words, which is just remarkable for this man. And the family members were even more worried now because they saw something in a measurable, quantitative way. That's when we knew that there's something specifically wrong. Those areas, those domains where he was making mistakes are specific for certain regions of the brain. We talk about lists.

We're talking about shifting sets. We're talking about inhibition or not getting frustrated when things are awry.

Those are frontal lobe activities. And although that doesn't right away point you to that, but when there's a constellation of those pointing in one direction, all executive function, all frontal functions, and then the other domains are relatively normal, then you say that there's something wrong. So when I explained this to the medical student, it was probably one of the most exciting moments because you basically show human cognition being broken into its different domains. We always think about human cognition and thinking in consciousness as one monosyllabic, one whole thing. It is that, it is a totality, but it's almost like a cloud of activities, elements working together to create consciousness. Often all the elements are fairly functional together, but one area is stronger than the other, and still within normal. But in these diseases such as frontotemporal lobe dementia, Alzheimer's, even Parkinson's, the different regions are affected disproportionately. For the audience that's not seeing this, I have a brain in my hand.

Ayesha Sherzai (4:16)

To be clear, it's a brain model.

Dean Sherzai (4:17)

That's right. It's not a gushy, soft, living brain. But in the frontotemporal lobe patients, as the name implies, the frontal lobe, the front of the brain is disproportionately affected. In fact, in some cases, when we're post-mortem, when you see the brain, the frontal lobe is actually shrunken. You can see it disproportionately. But on imaging, usually you can see it as well.