MEMORY DISORDERS CLINIC
At SCI’s Memory Disorders Clinic, we evaluate and treat cognition, memory, and learning or attention-related disorders across the lifespan. SCI clinicians provide targeted assessments for school-age children, adolescents, and young adults and we also conduct comprehensive neuropsychological evaluations for middle- or older-age individuals who are concerned with cognitive or memory changes that may or may not be associated with traumatic brain injury.
Cognitive changes are a natural part of the aging process. There are, however, differences in the degree of these changes across people, with some individuals enjoying preserved neurocognitive health into their 80′s and 90′s, and others experiencing more drastic decline and onset of neurodegenerative disorders at a younger age. In addition to genetic influences, research has identified important lifestyle factors that appear to partially account for this variability. There are increasing concerns, for example, regarding the relationship between repeated concussion and dementia due to chronic traumatic encephalopathy (CTE). Protective factors, however, include regular exercise, adequate nutrition (particularly B-vitamins and other phytonutrients found in many vegetables and fruits, as well as DHA/omega-3), avoiding smoking and excessive alcohol use, and proactive management of conditions such as high blood pressure, obesity and diabetes.
Subtle cognitive changes typically precede the onset of dementing disorders by as many as seven to 10 years. Mild Cognitive Impairment (MCI) has emerged as an identifiable condition and in some cases appears to be a transitional state preceding diagnosable dementia.
MCI is characterized by:
• Memory complaints (in amnestic MCI)
• Changes in language, attention or other mental functions that are noticeable, but not serious enough to interfere with activities of daily living, and not meeting criteria for a diagnosis of dementia
• Areas of normal or preserved cognitive functioning
• No other known medical or psychiatric condition to cause or fully explain the cognitive deficits
Knowing when cognitive changes are part of a normal, healthy aging process and when there may be cause for greater concern can be an anxious and stressful process. The highly skilled, multi-disciplinary clinicians at the Sports Concussion Institute can conduct an extensive and thorough evaluation to diagnose, rule-out, or treat even the most complex cognition and memory-associated difficulties.
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Patients with cognitive and memory complaints will undergo a full cognitive screening by a licensed Neuropsychologist as well as be evaluated by a Neurology doctor trained in the evaluation and treatment of dementia and memory disorders. Because other common conditions including vitamin deficiencies and thyroid dysfunction can either cause or exacerbate memory and cognitive problems or affect the recovery and improvement of these symptoms after a concussion, all patients are screened for treatable medical causes of memory problems though blood tests. Additionally, all patients undergo a neurological examination to evaluate for any signs of other disease processes that could be contributing to or causing the memory and cognitive problems. Neuropsychological examination has many important benefits in the treatment of individuals with cognitive and memory problems. At the Sports Concussion Institute state of the art computerized cognitive testing is utilized to determine how each individual is progressing in their treatment plan and also in the evaluation of age related memory complaints to determine when memory and cognitive problems are typical of those experienced aging individuals or if they may represent a new onset of a progressive dementing disorder. If a progressive dementing disorder is identified, such as Alzheimer’s disease, patients can receive medical treatment for their cognitive symptoms as well as interventions to aid with any behavioral, mood or other problems that may develop as part of the disorder.
Cognitive behavioral therapy and group therapy (group discussion/education sessions led by a licensed psychologist), are employed to augment the benefits of medications and to further educate patients regarding management of cognitive and memory problems. Group therapy sessions are particularly valuable to caregivers and loved ones who are taking on the responsibility for the first time of providing care to an individual who has been newly diagnosed with dementia or who have become dependent due to cognitive problems related to head injuries. Many times others who are going through similar circumstances can share valuable tips for coping and dealing with problematic behaviors. Additionally, the group dynamic can help to reduce stress experienced by caregivers and loved ones, as well as serve as a source of support and advice during difficult times. Many family members and caregivers are relieved to find out that others are experiencing similar difficulties and frustrations. Also, input from other group members can assist with difficult choices regarding transitions to a Nursing home or other care providing living situations when needed.
Communication and Education
Communication and education are one of the most important aspects of the Memory Disorders Program. Patients will be very well informed of the recommendations being made as well as the rationale for the recommendations, expected outcomes, risks, benefits and alternatives. This will include information outlining what the problem is, what brain structures are related to the memory or cognitive problems the patient is experiencing, what causes it, what can be done about it, and what to expect long term. Unbelievably, the majority of patients we see with memory problems due to brain injuries or dementias have never had this type of communication with any of their previous physicians. They may have been given a diagnosis and told they need treatment with a certain medication, or that nothing could be done for their symptoms, but they were never truly educated on the causes of the cognitive problems or their options for treatment and ongoing care. In addition, we will provide information regarding the rationale for all of our recommendations and encourage an active discussion of any concerns. Finally, the professionals at the Sports Concussion Institute engage in regular team meetings to ensure that all treating providers are on the same page with respect to the patient’s symptoms and progress.