I’m not as young as I used to be...How do I know if my symptoms are due to concussion or early dementia?

As a speech-language pathologist who has focused on treating adults with neurological deficits, I hear this question ALL. THE. TIME. It’s understandable that people become very concerned whenever they have changes in their memory. And unfortunately, there is no easy answer. But hopefully the information in this blog post will provide you with the information you need to help answer this question.

Unfortunately, many of the signs of early stage dementia are also symptoms of concussion. These common signs include forgetfulness, trouble concentrating as long as you used to, difficulty finding the right words, changes in behavior/mood, and difficulty completing daily tasks. Therefore, it can be very difficult to determine if you have dementia based solely on those symptoms. One of the biggest ways to differentiate between the two is that you can typically make progress and recover after a concussion, but dementia typically gets progressively worse over time. If you did not notice any difficulties prior to sustaining your concussion, and then acute changes occurred, that would lead me to believe that the issues are concussion related. It is also possible that you are experiencing some normal cognitive decline (we call that getting older).

Once someone reaches us for treatment, we will typically perform a cognitive assessment.  After a period of time, we will re-assess the patient.  If the patient’s performance worsened, we would typically recommend a neuropsychological assessment, which can help determine the nature of the difficulties.  For most of the patients we see, the decline is related to factors other than dementia.  If there is some concern for a neurological process other than concussion, the neuropsychologist and/or neurologist will consider brain imaging, family history, and lab work to determine if a dementia (or other) diagnosis is applicable.  These tests will provide valuable information for treatment options, as well as comparison data for any future testing. 

If you are concerned, please schedule an appointment with your physician. Doctors are trained to differentiate between the two and to guide you on your path into aging. (Side note- you should consider seeing a physician who specializes in geriatric medicine.) Either way, early recognition is key. The sooner you know, the earlier you can do something about it! Cognitive therapy could be beneficial to learn some strategies to improve and/or maintain your functioning. 

If you think you’re having cognitive issues after sustaining a concussion and would like some help, call our office to schedule an appointment with one of our speech-language pathologists, who have spent countless hours specializing in cognitive rehabilitation.

Colorado Concussion Clinic 303.932.2030 

- Hilary Booco, MA CCC-SLP

How Does Impaired Hearing Impact Cognition?

Did you know that hearing impairment is a common symptom after sustaining a concussion?  Many people are aware of post-concussive symptoms such as headaches, dizziness, or memory loss, but are less familiar with the possibility of hearing impairment.  Some people experience hearing loss while others may experience symptoms such as difficulty processing auditory information, ringing in the ears, or sensitivity to noise.  It varies significantly by person, but these symptoms can sometimes have a profound effect on your life. 

You might be surprised to learn that even mild hearing impairment can impact a person’s life and daily functioning.  In fact, research shows that even mild hearing impairment is associated with a faster rate of cognitive decline as well as an increased risk of dementia.  In this blog, we’re going to discuss several examples of different areas of cognition that are directly impacted by a hearing impairment in addition to some tips to help you alleviate these challenges.  

First, it is important to mention that if you are concerned that your hearing has changed in any way since your concussion, it will benefit you to:

1. Make an appointment with a certified audiologist for a hearing evaluation.  

2. Follow the audiologist’s recommendations.  There are many treatment options such as amplification technology (e.g., hearing aids, amplified telephones) or aural rehabilitation that may include auditory training, counseling, or learning strategies to help you hear better in situations you have more trouble.

Now, here’s where we dive into some of the specific areas of cognition that are often affected:

Hearing impairment can directly impact your ability to pay attention and concentrate on information you are listening to.  This is because your brain has to work extra hard to decode and understand the information.  This may cause you to experience cognitive overload and fatigue, both of which make it difficult to pay attention.  

So, what are a few ways you can improve your attention in these situations? 

• Modify your environment by reducing background noise or moving into a less distracting location

• Sit or stand near the speaker 

• Consider using amplification technology (e.g., conference microphones, amplified telephone)

Hearing impairment can impact your memory.  When our patients have trouble staying focused while listening, they often experience difficulty remembering the information they hear.  This is because attention is a foundational skill that is necessary for the formation of memories.  And, when concentrating and listening become so effortful, people often experience decreased memory. 

So, what are some things you can do to improve your memory?  

• Continue to practice and master the attention strategies mentioned above 

• Ask people to repeat what they said 

• Take a moment to stop and briefly summarize what you heard in your own words 

• Take notes that you can refer to later 

Hearing impairment can impact your ability to engage in effective communication with others.  As you can imagine, if you have trouble paying attention or remembering details you hear, it will be difficult to follow along during conversations, especially when there are multiple people speaking.  You might even feel like other people are mumbling because it is difficult to understand them.  If you miss important details, this can easily lead to a miscommunication.  And, after socializing, you may feel cognitively exhausted because of all the extra effort you used to listen and stay engaged. 

What types of strategies can help you improve your communication in these situations?

• Face the person you’re talking to so you can use both auditory and visual cues (reading lips) to help with understanding.

• Advocate for yourself ahead of time. Let people know about your hearing impairment.  Ask them to speak a little louder, slower, and only one person at a time.

• Ask questions to clarify that you understood. 

By addressing your hearing impairment with a full audiological evaluation and following through with the recommendations for treatment, you can improve your ability to concentrate, remember the details, communicate effectively with others, and your overall quality of life.  

And, if you are having any difficulty implementing the strategies outlined above or are looking for additional cognitive support, the licensed cognitive therapists at the Colorado Concussion Clinic are here to support you! 

- Mari Gottlieb, MA CCC-SLP

Four Ways to Manage Fatigue From a Cognitive Perspective

Fatigue is one of the most common symptoms our patients report after they experience a concussion.  It can reveal itself physically, cognitively, or even emotionally.  Our group of speech language pathologists at the Colorado Concussion Clinic often work with our patients to manage each type using a holistic and individualized approach to cognitive therapy.  While there are many different ways to treat fatigue, here are four ways we might address it in therapy with you:

#1:

First, it is important to understand your triggers for fatigue (e.g., loud noises, poor sleep quality, etc.) and the type of fatigue you experience depending on the activity you complete.  We may recommend you begin logging or tracking your fatigue levels during the day to help increase your awareness.  For example, you might find that some activities are emotionally or physically fatiguing, or both.  Our goal is to help you tune into this and pay attention to the way each activity makes you feel.  Having this level of insight can help you adjust your schedule to better suit your needs.

#2:

We recommend creating consistent routines to follow during the day to help conserve your energy.  Doing so will decrease the need to make decisions throughout the day, which often takes more time and energy than expected.  We’ll help you identify routine tasks and create a consistent schedule for these throughout your week.   Following a routine will also improve your ability to focus and remember to complete those tasks. 

#3:

Next, we may teach you how to strategically plan your day based on the information we learn through your fatigue log while also helping you maintain your routines. We often recommend that you complete tasks in a specific way to conserve your energy such as – planning a rest break before and after your physical therapy appointments, or completing a cognitively challenging task in the morning when you have the most energy.  Our intention is to teach you how to plan your day to maximize your energy and manage your symptoms proactively. 

#4:

Finally, to improve your energy levels and reduce fatigue, it is always important to prioritize activities that promote overall wellness and a healthy brain, especially after sustaining a concussion.  To manage this from a cognitive perspective, we may help you develop goals for your sleep or exercise routines, or help you start incorporating stress management techniques into your day.  We all know how easy it is to forget even the simplest things that are good for us, like maintaining a good sleep schedule or prioritizing your mental health.  And after a concussion, these things may feel like more of a challenge.  Our goal is to guide and support you in reaching your goals, and help you feel more like yourself as soon as possible! 

- Mari Gottlieb, MA CCC-SLP