Lots of anxiety about neuropsychological testing appointment

[marymac]

A little background about me - 49 years old, early menopause at 37 (HRT since then), lab results (the good - HDL 94, LDL 67, total cholesterol 181, Homocysteine 5.6, the bad A1C 5.6, Omega 6/3 ratio 9.3), low BMI at 106 lbs, 5'6". I do not know my APOE status. My parents don't have Alzheimers, but my maternal grandmother did. I've been worried about my cognitive functioning for a few years now. I read Bredesen's book when it was released and have been trying to follow his recommendations for healthy eating, exercise, supplements, etc. My main concern is with brain fog and speaking (memory is not great but not my biggest concern at this point). Brain fog is bad when I'm trying to learn something new or reading something that's unfamiliar. I've also noticed that when I'm having a conversation with someone, it takes a lot of mental energy just to stay focused. When speaking (especially when stressed or in a hurry) I'll say the wrong words, or have to pause in the middle of a sentence to make sure the words coming out are actually the words I'm thinking. Once I was thinking "2nd grader", but the words that came out in the conversation were 2nd year old. Another time, I was meeting a friend somewhere and when I saw her, she asked when I had arrived - my answer was "soon". I made an appointment with a neurologist who recommended an MRI. He said the results showed I had normal, healthy volume in all areas of my brain. He is concerned about my speaking issues and wants me to see a neuropsychologist for testing next month.
I can't stop worrying about the test. My heart is racing just writing about it. Any tips for coping with the fear of low scores or a scary diagnosis? I thought I wouldn't have to worry about dementia before the age of 50, but here I am, sick with anxiety.

[NF52]

A little background about me - 49 years old, early menopause at 37 (HRT since then)...I do not know my APOE status. My parents don't have Alzheimers, but my maternal grandmother did. I've been worried about my cognitive functioning for a few years now....Brain fog is bad when I'm trying to learn something new or reading something that's unfamiliar. I've also noticed that when I'm having a conversation with someone, it takes a lot of mental energy just to stay focused...I made an appointment with a neurologist who recommended an MRI. He said the results showed I had normal, healthy volume in all areas of my brain. He is concerned about my speaking issues and wants me to see a neuropsychologist for testing next month.
I can't stop worrying about the test. My heart is racing just writing about it. Any tips for coping with the fear of low scores or a scary diagnosis? I thought I wouldn't have to worry about dementia before the age of 50, but here I am, sick with anxiety.

Hi marymac,
As someone who used to give lots of diagnostic tests to kids, and who worked with neuropsychologists who gave tests to kids and adults, I never really had an appreciation for test anxiety until I had to take a huge battery of tests as part of a clinical trial for adults with ApoE 4/4 ages 60-75. Here's the good news: some of these tests are designed to be fast, basic screening for cognitive issues and they start with those, so you'll be able to settle in a little. Then they branch out to lots of areas that are just looking to put together a picture of how your brain handles information. So there's no worries if you can't draw as well as the average 10 year old (hand raised here), because you probably do just fine on other tests. None of the tests are like taking high school or college exams where you have to remember ancient information. The tests simply help to tell the story of how you learn, hold onto and retrieve information. The fact that you have a normal MRI, no memory concerns and your age make it extremely unlikely that you have any sign of early dementia! You don't say how old your grandmother was when she died with dementia, but almost no one was clinically diagnosed with Alzheimer's 30-40 years ago. Much more recently, 30% of autopsied cases of "diagnosed" dementia were found to not have Alzheimer's.

Your example of saying "soon" when you might have meant "recently" is a great example of what a professor of cognition called our brains acting like the kid whose hand is always raised first in class: We're reaching for a word that expresses a time concept that means "close to now, but not now" and our lexical memory for words prompts "soon". Same with "2nd year old" for "2nd grader". In fact, the closer words are in meaning, or usage, the more likely we are to incorrectly retrieve them. I am famous with my 3 kids for when they were younger and I was always doing 3 things at once for calling out at least one wrong name when I knew exactly who was in front of me!

Here's what else jumps out at me: you have this when you are in the midst of a conversation and "it takes a lot of mental energy just to stay focused" and you also see this when you are learning something new. Both of those require attentional focus. With new info, we have to have enough focus to hold onto the new thing, while we search our brains to find a link to a prior category or "mental map". If our attention is interrupted, or somewhat "twitchy", we find we've lost the new info, or the thread of the conversation, or the word that we wanted. And guess what affects attention: anxiety! and fatigue! and stress!

So I would suggest that before the neuropsychologist starts the test, you share with her/him those examples and let that person know that you are nervous about the test. They can always start with easier items, and give you time for stretching, relaxation breathing, and even sharing a story about something that's going well. That normal MRI is something to celebrate; now you just have to work with some Sherlock Holmes diagnosticians to help you understand what works best for your brain to be happy! And most neuropsychologists I've met enjoy helping people learn how their brain works!

[Lisa G]

...the results showed I had normal, healthy volume in all areas of my brain. He is concerned about my speaking issues and wants me to see a neuropsychologist for testing next month.
I can't stop worrying about the test. My heart is racing just writing about it. Any tips for coping with the fear of low scores or a scary diagnosis? I thought I wouldn't have to worry about dementia before the age of 50, but here I am, sick with anxiety.

Hi MaryMac. I can empathize with the anxiety and fear around a neuropsychology test. I felt the same when I was applying for long-term care insurance and I had to go through a battery of tests to determine my cognitive functioning. I just wanted for the day to come and to get the test over! While I don't know what to say that could ameliorate your anxiousness, I could suggest that you practice relaxation techniques such as deep breathing or progressive muscle relaxation (I like doing this as it is an "active" meditation!). You could also search Youtube for some guided imagery meditations. I just listened to one today and I am always amazed how it takes me to another, calmer place. You could also journal about your feelings and possibly even challenge your anxious thoughts. You could ask yourself if you are being realistic or if you are creating worst-case scenarios. There is also the strategy of interrupting your negative thoughts and replacing them with good, happy thoughts. While I know you are worried, it's all about how you manage and deal with the stress of the unknown. And you have control over that. Hope this helps a little!

[marymac]

Your example of saying "soon" when you might have meant "recently" is a great example of what a professor of cognition called our brains acting like the kid whose hand is always raised first in class: We're reaching for a word that expresses a time concept that means "close to now, but not now" and our lexical memory for words prompts "soon". Same with "2nd year old" for "2nd grader". In fact, the closer words are in meaning, or usage, the more likely we are to incorrectly retrieve them. I am famous with my 3 kids for when they were younger and I was always doing 3 things at once for calling out at least one wrong name when I knew exactly who was in front of me!

Here's what else jumps out at me: you have this when you are in the midst of a conversation and "it takes a lot of mental energy just to stay focused" and you also see this when you are learning something new. Both of those require attentional focus. With new info, we have to have enough focus to hold onto the new thing, while we search our brains to find a link to a prior category or "mental map". If our attention is interrupted, or somewhat "twitchy", we find we've lost the new info, or the thread of the conversation, or the word that we wanted. And guess what affects attention: anxiety! and fatigue! and stress!

Thank you so much for writing this! I already feel less stressed about my speech problems. I know these issues got worse when I started googling it - primary progressive aphasia and other types of dementia sounded a lot like what I was experiencing. I started to analyze everything I was thinking before I said it bc saying it the wrong way always increased my stress and depression. I know this constant "watchfulness" is making things worse. I can't thank you enough for easing my mind about the testing!

I could suggest that you practice relaxation techniques such as deep breathing or progressive muscle relaxation (I like doing this as it is an "active" meditation!). You could also search Youtube for some guided imagery meditations. I just listened to one today and I am always amazed how it takes me to another, calmer place.

Thank you! I will check Youtube for the meditations - is there a channel you really like?

[Lisa G]

Great Meditation is a channel I've used. Today my guided meditation was different -- one with Mary for Advent.

[marymac]

Thank you, Lisa G!

[floramaria]

When speaking (especially when stressed or in a hurry) I'll say the wrong words, or have to pause in the middle of a sentence to make sure the words coming out are actually the words I'm thinking. Once I was thinking "2nd grader", but the words that came out in the conversation were 2nd year old. Another time, I was meeting a friend somewhere and when I saw her, she asked when I had arrived - my answer was "soon".

Hi,marymac. Your experience of replacing the word you intend to say with a related but different word is very familiar to me. It was really alarming to me when I would hear the wrong word come out of my mouth when I knew full well what I meant to say. As with you, for me this would intensify when I was stressed or in a hurry.
Dr Bredesen states that this sort of problem with speech tends to correlate with toxicity. What symptoms of cognitive problems manifest is one of markers used to figure subtypes. (You can find reference to this this in The End of Alzheimer’s, 158-159)
Personally I found it helpful to have this tidbit of information related to this specific problem I was experiencing since it helped me put special focus on detoxification, in the midst of the many areas where modification and optimization are advised. I have found that over the past couple of years, following Dr Bredesen’s protocol, I am doing “word replacement” much less.
Hope this may be helpful to you too.

[marymac]

Personally I found it helpful to have this tidbit of information related to this specific problem I was experiencing since it helped me put special focus on detoxification, in the midst of the many areas where modification and optimization are advised. I have found that over the past couple of years, following Dr Bredesen’s protocol, I am doing “word replacement” much less.

Thank you for sharing your experience! It's always helpful to know that other people have experienced this issue (I recall in Bredesen's book someone else talking about saying the wrong words like what she was having for dinner instead of the child she was calling in for dinner). I've been on menopause forums where this topic has come up as well, and since I went through menopause over a decade ago, I've often wondered how much it's affecting my brain. I do suspect I have toxicity - heavy metals and possibly mold and will get that checked at my next physical. I'm curious what you used to detoxify? Any supplements you recommend? What test results showed your issues? I'm so relieved that this is a problem that has improved for you. It gives me lots of hope!

[floramaria]

Thank you for sharing your experience! It's always helpful to know that other people have experienced this issue (I recall in Bredesen's book someone else talking about saying the wrong words like what she was having for dinner instead of the child she was calling in for dinner). I've been on menopause forums where this topic has come up as well, and since I went through menopause over a decade ago, I've often wondered how much it's affecting my brain. I do suspect I have toxicity - heavy metals and possibly mold and will get that checked at my next physical. I'm curious what you used to detoxify? Any supplements you recommend? What test results showed your issues? I'm so relieved that this is a problem that has improved for you. It gives me lots of hope!

Hi marymac, I did not see your reply until now since
when you quoted me, which would have notified me that you'd replied to my post, my words showed up as a quote from you. (Check out Quoting a post section of Wiki f you need help with that.)
I don't have much time today, but within a day or two I will post answers to your questions about the testing and the detox protocols I am using. For now, I just want to acknowledge your reply and let you know I'll get back to you.

[circular]

Hi MaryMac. I can empathize with the anxiety and fear around a neuropsychology test. I felt the same when I was applying for long-term care insurance and I had to go through a battery of tests to determine my cognitive functioning...

Hi Lisa, this rather shocked me. I've never known an LTC company to require neuropsychological testing to obtain insurance. Was this recently and it's a new thing they're doing in underwriting, or was it so long ago that it was before standardized LTC policies and practices?