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A Practice Grounded in Geriatric Clinical Neurology
Dr. Sabrina Diab completed her doctoral internship at the Memory Clinic of the Jewish General Hospital, a leading Quebec setting for neuropsychology of aging and the assessment of neurodegenerative disorders. This training grounds her practice in the nuanced reading of geriatric cognitive profiles and in the differential diagnosis among the various possible causes of dementia.
Dementia and Neurodegenerative Disorder Assessment in Montréal
A clear diagnosis to guide the next steps.
Neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, or frontotemporal dementia develop gradually and affect several cognitive functions. Neuropsychological assessment clarifies their nature and extent, and concretely guides care.
Neurodegeneration
Neurodegenerative disorders and dementia, from a clinical perspective
Neurodegenerative disorders are brain conditions marked by a progressive loss of neurons that leads to cognitive, motor, or behavioral decline. When this decline reaches a point where it compromises independence in daily activities, it is referred to as dementia, now described as major neurocognitive disorder in the DSM-5. Diagnosis relies on precise clinical characterization, an in-depth cognitive assessment, and often ruling out other potential causes such as depression, a sleep disorder, or a medication effect.
Clinical Expertise and Research | Doctoral thesis (Psy.D.) · Université du Québec à Montréal · 2023
Mood and sleep symptoms in Parkinson's disease in relation to mild cognitive impairment
Dr. Diab’s doctoral research focuses directly on one of the clinical profiles addressed in her practice. This expertise informs her reading of cognitive profiles in neurodegenerative conditions.
The research explores the links between mood symptoms, sleep disturbances, and the emergence of mild cognitive impairment in people living with Parkinson’s disease. The study combined neuropsychological assessment, neurological examination, and polysomnography to characterize a clinical profile rarely documented in private practice in Quebec.
The Typical Progression
How Dementia Changes Over Time
Neurodegenerative disorders progress through stages that help guide care and family discussions. The assessment documents the current stage and supports upcoming adjustments.
Early Stage
The first signs affect a dominant cognitive function depending on the cause, such as memory in Alzheimer’s disease or behavior in frontotemporal dementia. Independence is preserved in most activities, but certain complex tasks begin to require more effort.
Moderate Stage
Several cognitive functions are affected, and the impact becomes visible in daily life. Independence in complex tasks decreases, and more sustained support becomes necessary, particularly for managing finances, medications, and transportation.
Advanced Stage
Dependence for daily activities increases. Language may become more limited, recognition of loved ones may falter, and constant support becomes necessary. The assessment has already taken place; the role of follow-up is to adjust care and support caregivers.
The Role of Longitudinal Follow-up
When the diagnosis is made at an early stage, periodic neuropsychological follow-up documents progression, guides medical decisions, and helps families anticipate adjustments. Not every stage follows exactly the same trajectory, depending on the underlying cause.
Dementia or Alzheimer's
Understanding the Difference Between Dementia and Alzheimer's Disease
Confusion between dementia and Alzheimer’s disease is common among the public. Dementia is a clinical picture, that is, a set of symptoms reflecting significant cognitive decline. Alzheimer’s disease is a specific cause of dementia, the most common one, but not the only one. Other conditions such as vascular dementia, Lewy body dementia, frontotemporal dementia, or mixed forms can also produce a dementia picture with a distinct cognitive profile.
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Why Differential Diagnosis Matters
Identifying the exact cause concretely changes the care plan. Medication treatment, prognosis, guidance recommendations, and support pathways vary depending on whether it is Alzheimer’s, vascular dementia, Lewy body dementia, or frontotemporal dementia. This is precisely where neuropsychological assessment adds value, by objectively documenting the cognitive profile and contributing to the differential diagnosis alongside the treating physician or neurologist.
Early Signs to Watch For
What Might Prompt an Assessment, for Yourself or a Loved One
Here are signs frequently reported by those affected or their caregivers that may justify a clinical assessment.
- Recent memory lapses that keep adding up, particularly for events from the past few days or weeks
- Difficulty finding words, following a complex conversation, or reading a familiar text
- Disorientation in familiar places or in managing time and appointments
- A change in behavior, judgment, or personality that surprises the family
- New difficulties managing finances, medications, or everyday devices
- Significant cognitive fluctuations, with moments when the person seems almost normal and others when they appear very confused
- The appearance of motor symptoms such as tremor, slowness, or rigidity alongside cognitive difficulties
- A sense, in the person or their loved ones, that the difficulties go beyond what can be explained by age, fatigue, or depression
The Geriatric Assessment
What the Neuropsychological Assessment for Neurodegenerative Conditions Includes
The geriatric assessment combines several clinical tools to document the cognitive profile and contribute to the differential diagnosis.
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Clinical and collateral interview
Medical, medication, and developmental history. A description of current difficulties and the onset and progression of symptoms. A significant part of the interview takes place with a caregiver, who offers an essential perspective on changes observed over time.
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Global and Targeted Cognitive Testing
Administration of global measures such as the MoCA or MMSE, complemented by a detailed neuropsychological battery exploring memory, language, executive functions, attention, visuospatial cognition, and social cognition according to the clinical picture.
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Integrated Analysis and Differential Diagnosis
Connecting the cognitive profile with the clinical history to point toward the most likely cause, rule out reversible causes such as depression or a medication effect, and clarify the stage of the condition when the diagnosis is already established.
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Report and Recommendations
A clinical report is presented to the person assessed and, with their consent, to caregivers. Concrete recommendations are provided for daily life, medical follow-up, administrative steps such as applying for government benefits, and referrals to relevant community services.
Before you consult
The Questions Most Often Asked by Patients and Their Loved Ones
If your question isn’t on this list, reach out directly to discuss it.
Dementia is a clinical presentation referring to a cognitive decline significant enough to affect independence in daily life. Alzheimer’s disease is a specific cause of dementia, the most common one. Other causes include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed forms. The clinical assessment clarifies the most likely underlying cause.
The main forms are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and dementia associated with Parkinson’s disease. Each presents a distinct cognitive profile, and mixed forms also exist. The neuropsychological assessment documents the profile and contributes to the differential diagnosis.
A consultation is recommended when memory lapses, language difficulties, behavioral changes, or a loss of independence go beyond what would be expected for the person’s age, or when a physician recommends an assessment to help guide a diagnosis. It is often best to consult early, since an accurate diagnosis helps guide care sooner.
It is an in-depth clinical assessment that combines an interview, standardized tests, and an integrated analysis to document an older adult’s cognitive profile. It contributes to the differential diagnosis of neurocognitive disorders, clarifies the stage of the disease when it has already been identified, and guides recommendations for the person and their loved ones.
A formal diagnosis of Alzheimer’s or Parkinson’s disease is made by a physician, neurologist, or geriatrician. The neuropsychological assessment makes an essential contribution by documenting the cognitive profile, ruling out other possible causes, and clarifying the stage of the disease. It is part of a multidisciplinary approach.
Yes. The initial interview often includes a caregiver, who can offer valuable observations about how the difficulties have evolved. Testing sessions take place one on one with the person being assessed, to preserve the reliability of the measures. Family members can then be present when results are shared, with the person’s agreement.