When You are Looking for a Memory Assessment
By Hillel Grossman, M.D.
Everyone over a certain age has had the experience of running into a former coworker and not remembering her name; of dashing into the kitchen during halftime and not being able to recall why you are in the kitchen. What do these experiences represent? Normal aging? Emerging dementia? Early Alzheimer’s disease? Does it matter how old I am? If I have a relative with dementia?
These questions should not be answered off the cuff by your neighbor’s nephew who works for a drug manufacturer and pondered going to medical school. These questions require a careful collection of the facts, some reflective consideration, and a patient response.
If these are your questions, then you might be looking for a memory assessment. A memory assessment has three components:
A medical history that includes a careful questioning of memory- dependent activities, family history, educational history, and academic performance, as well as an investigation of other areas such as occupational history including toxic exposures;
A neurological exam including a measurement of motor and sensory function and an assessment of cognition in multiple domains such as memory, language, calculations, attention, flexibility, and psychomotor speed;
Laboratory and brain imaging.
The core of the evaluation is the history and the exam. It requires a careful and deliberate process to get the answers. Sample questions include: Do you ever misplace things? When you can’t find your wallet do you end up replacing it or does it turn up later that day?
As you might imagine, this exam takes time. It requires patience to allow an anxious and perhaps slowed patient to answer questions carefully. It cannot be boiled down to a five-minute screen in which you list a few presidents and repeat a few words.
There are a range of brain imaging tests (head CT, MRI, FDG-PET, amyloid-PET, tau-PET) that each answer different questions about brain anatomy and function. A memory evaluation requires some specialized skill to determine which of these expensive imaging tests might be relevant to each patient. Office testing may need to be supplemented with more extensive memory testing with a neuropsychologist. These determinations of which test to obtain and how to integrate the findings into a clear diagnosis with a meaningful prognosis require particular expertise reflecting specialized training and experience.
So where can you get such an assessment? Your internist/primary care practitioner is tasked with taking care of your blood pressure, blood sugars, back pain, night sweats, and myriad other ailments and sorting through it all in a 15-minute speed- talking encounter. Your gynecologist or urologist is focused at a different level of the body. You need a memory doctor. This type of specialist may have trained as neuropsychologist, geriatrician, behavioral neurologist, or geriatric psychiatrist and may be situated at a specialty memory center. The key is that such an expert has spent years doing these diagnostic evaluations and treating people with memory disorders.
The New York metropolitan area is particularly fortunate to have three Alzheimer’s Disease Research Centers (ADCs) funded by the National Institute on Aging to develop, research, and provide resources related to the diagnosis, management, and treatment of memory disorders. The ADCs are sited at the Columbia, NYU, and Mount Sinai medical centers. If you are wondering if you or someone you know needs a memory evaluation, now is the time to call.
Hillel Grossman, M.D., is the Medical Director of the Clinical Core at the Alzheimer's Disease Research Center at the Icahn School of Medicine at Mount Sinai.