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What
constitutes a good memory evaluation?
A memory evaluation should include an initial consultation, a selected battery of neurocognitive tests, laboratory testing of blood, MRI and functional brain scans to
arrive at a diagnosis. Treatment is optimized through a multi-modal approach.
More information on our
diagnostic and treatment staff.
The initial
consultation:
This generally consists of an extensive history, general medical,
neurological and
specialty examination lasting an hour. Following this initial evaluation, a
patient may then require no further testing, or may require one or more of the following
evaluations:
Neurocognitive
testing:
These tests are designed to elicit disturbances in memory and thinking. Just as a cardiac
stress test is helpful in diagnosis, treatment and prevention of heart diseases and heart
attacks, appropriately administered and properly interpreted neurocognitive tests are
invaluable in brain dysfunction. Depending on the symptoms, individual
tests are selected to best evaluate each associated brain area. Testing lasts about four to five hours.
Laboratory work-up
As part of a diagnostic work-up, in some patients, a laboratory work-up is performed. This
work-up eliminates treatable causes of memory disorders. This may include tests for
anemia, vitamin levels, thyroid and ovarian hormone levels and tests for chronic
infections, such as Lyme. On occasion, tests for auto-immune illnesses, vasculitis, lead
and other heavy metal levels, or genetic testing is performed. Genetic testing is a
controversial area and should only be approached after the patient and family have been
counseled. It is indicated only in a small group of patients. Determining the
Apolipoprotein E genotype is necessary in rare situations.
Neuroimaging if needed (MRI, SPECT, PET)
Brain imaging includes both structural (CT scan or MRI scan) and functional imaging (SPECT
or PET scan). CT or MRI scans are performed to rule out ‘mini-strokes’ or other
structural causes for memory loss. At times, these strokes are ‘silent’,
manifesting mainly with memory loss, rather than paralysis or other such difficulties.
SPECT or PET scans evaluate brain functioning rather than structure. These scans measure
blood flow to brain regions or the use of nutrients by areas of the brain. Such scans help
pinpoint areas of difficulty when an MRI or CT scan is normal. Other functional imaging
techniques include functional MRI. Generally, functional imaging of the brain is
not performed routinely, but only in a subset of patients with
memory difficulties, where there may be diagnostic difficulties. For
the genetic counseling and caregiver support programs, the consultation
will be geared to address these issues and will not usually involve testing. Instead
information about the affected family member will be needed to answer an individual’s
concerns.
Some patients require an
electroencephalogram or EEG, an evaluation of brain function by
monitoring brain electrical activity, produced by individual
nerve cells.
After a
diagnosis was made:
Once these tests have been completed, a diagnosis is made and a treatment plan is
formulated. The patient (and family, if desired) meets with the physician for an informing visit that is
an hour long, going over all results of
the testing. The treatment plan is then discussed and finalized in conjunction with the
patient and the family.
The treatment plan:
Medications and behavioral treatments for treatment of memory
disorders related to menopause, Alzheimer's disease, and other
disorders are prescribed as needed. Cognitive rehabilitation, with strengthening of weakened skills (such as language), and
strategies for coping with and overcoming deficits in memory are used in others.
If you would like to make an
appointment or for further information, you may contact us
at 212 517 6881. Our office hours
are Mondays through Thursdays, from 9 AM to 5 PM.
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Please note that all material contained herein is provided for informational purposes
only and should not be considered as medical advice or instruction. Consult your health
care professional for advice relating to a medical problem or condition. Please also read
the disclaimer section.
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