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Melanie Cole (Host): The Center for Success in Aging’s Memory Program offers a comprehensive evaluation which includes medical, cognitive, social and physical evaluation to diagnose memory conditions, and develop a plan for caring for patients and their family members. My guest today is Dr. Jim Davis. He’s an internal and geriatric medicine specialist at Greenville Health System. Welcome to the show, Dr. Davis. So, first let’s talk about who may benefit from a memory health program assessment.

Dr. Jim Davis (Guest): Well, several people might. The main focus of our program is helping caregivers of patients who have dementia, who have Alzheimer’s disease or other forms of dementia, and that’s the main focus of the program. We also provide consultations for people who might be experiencing problems with memory, who have other concerns about memory or memory function, people who may be wondering, “Could I be developing Alzheimer’s disease.”

Melanie: So, there are different types of dementia, and not every dementia and memory issue is Alzheimer’s, correct?

Dr. Davis: That’s correct.

Melanie: So, people confuse that?

Dr. Davis: I beg your pardon?

Melanie: People confuse that. Would you just clear it up for us?

Dr. Davis: Sure. Dementia is a general term. Dementia describes a set of symptoms, and those symptoms are related to loss of brain function. It might be memory; it might be language but other forms of brain function that are lost and the degree is such that it interferes with a person’s ability to carry on their daily activities. So, that’s a general term to define dementia. Dementia might be due to playing professional football, being a boxer, suffering from alcoholism. There are a hundred conditions which can lead to that syndrome or that condition of dementia. Alzheimer’s is a specific cause of dementia, and it’s the most common cause of dementia. But, the two terms are sometimes used interchangeably when actually they mean something a little different.

Melanie: Dr. Davis, we all experience memory issues from time to time. What are some red flags that would signal, from a loved one or if you notice it yourself, that would send you for an assessment?

Dr. Davis: I think if memory problems interfere with daily activities. So, for example, if you have a problem, and you’re forgetting to pay bills. If you have a memory problem and you’re headed somewhere in your car and you forget where you’re going or you get lost while driving. A memory problem that can result in forgetting to take medications repeatedly can get someone into trouble. So, all of us experience changes in memory as we get older. It’s not uncommon to forget a proper name, sometimes even of somebody we know. But, when that becomes pervasive or a more common problem, an adult who’s forgetting the names of all their grandchildren, that might be a sign that there’s a problem, particularly if they see their grandchildren often and then can’t remember their names. I would look for a memory problem that’s starting to interfere with important activities like paying bills, keeping up with medication, remembering appointments, remembering anniversaries, things like that. So, when it gets to that point, I think that needs to be evaluation.

Melanie: So, what’s the evaluation like? Are there any specific tests for the type of dementia?

Dr. Davis: The first part of it is a very careful history and careful medical examination. Memory is just one part of brain function. So when you’re evaluating your memory problems, you’re evaluating them in the context of overall health. For example, there may be medications that you’re taking for heart disease or medications you’re taking for diabetes. Any of these could affect brain function. So, the first thing is a careful health assessment, careful medication review. And then, we focus on a physical exam that includes assessing things like vision and hearing to make sure that those are being managed optimally. And then, certainly a careful neurologic exam. We do some standard screening tests for memory function and for brain function. The one we use here in our office is called the MoCA. It stands for Montreal Cognitive Assessment and it’s been around for years. But the Mini-Mental Status exam is another, and there are others screening tests that can be used to evaluate people who are experiencing problems with memory. Based on that test, we can get a sense of is there a problem or not, and, in some cases, how severe is it. Additionally, certain laboratory studies ought to be done to exclude conditions like thyroid disease or severe vitamin deficiencies. And, occasionally, a brain scan either a CT scan or an MRI might be helpful to exclude other conditions.

Melanie: And, if you diagnose cognitive decline of whatever type, what kinds of treatments are available?

Dr. Davis: Well, there are certainly non-medical treatments. So, we almost always recommend that a person exercise regularly, follow a proper diet, and we also want to encourage social engagement so that the person who’s got problems keeps their mind active in any way that they can through social engagement. There are a couple of types of medications that are available that will slow the decline in cognitive function. So, sometimes we recommend those. Those medications need to be used carefully. They have side effects, and so we always want to recommend medication carefully. We also want to know to stop medications which can aggravate cognitive function. So, certain types of medications need to be avoided or limited in order to improve memory function. We also want to identify people who have depression so that we can treat depression as a separate problem in some ways because depression can affect memory and concentration.

Melanie: So, tell us about the Center for Success in Aging’s Memory Health Program at Greenville Health System. Tell us a little bit about your team and what an evaluation is like--what patients can expect.

Dr. Davis: We have a team of myself, two nurse practitioners and a social worker, and we have an excellent nursing staff for all of our activities. The initial assessment includes a visit with either me or with the nurse practitioner. So, the patients I see, tend to be people who do not already have a diagnosis of dementia or Alzheimer’s disease. And so, I’ll see those patients and do an assessment to determine whether or not they would be appropriate for our memory care program. Other patients who’ve already been diagnosed with dementia and have a caregiver involved go directly to see the nurse practitioner. The nurse practitioners do a very thorough medical evaluation. And, we also assess the needs of the caregiver at the same time. And then, we bring in the social worker as needed to address various issues that come up in planning for the care of someone with dementia.

Melanie: And, what about their families, Dr. Davis, how do you work with their families because sometimes this is just as hard, if not harder, on the loved ones because they’re the caregivers and it hurts to see somebody losing that part of their life.

Dr. Davis: Well, that’s an excellent point, and that’s why I said at the very beginning, the real focus and the main focus of our program is on the caregiver. It’s true. We have two patients in the room often, and often the one that’s suffering the most is the caregiver. So, in addition to the counseling and education a nurse practitioner provides at every visit, we have classes, there’s a class called “The ABCs of Dementia” that takes place three times a year, and that’s six classes that’s really open to the public. But, we encourage all of our caregivers to attend, and they learn all about Alzheimer’s disease. They learn all about the different issues that come up in terms of care planning and management. We also have an Alzheimer’s support group here that takes place in our office and meets on a monthly basis to provide emotional support. We work closely will community agencies like the Alzheimer’s Association and other community agencies that are involved in caring for people with Alzheimer’s disease, and assisting caregivers. So, we are a conduit to all of those services that may be available in the community.

Melanie: So, in just the last few minutes, Dr. Davis, it’s such important work that you’re doing. Give us your best advice for memory health, in general, and why patients should come to Greenville Health System for their care.

Dr. Davis: Well, I think the best advice for all of us is prevention. So, certainly avoiding things that can affect brain function. For example, staying healthy, avoiding cigarette smoking and managing chronic medical conditions throughout the life span. Heart disease, hypertension, diabetes--all of these are factors for brain disease. So, staying physically active, staying mentally active, and managing chronic health problems is the first step in trying to avoid the development of dementia. If these problems develop, as they often do, then the earlier you can get in and get an assessment, the better because that helps with planning for care going forward. One another aspect is that our program is a co-management program. By that, I mean we work very closely with the primary care physician so that we help manage all these other health problems that a person may have in addition to the dementia.

Melanie: Thank you so much for being with us today, Dr. Davis. You’re listening to Inside Health with Greenville Health System. For more information, you can go to ghs.org. That’s ghs.org. This is Melanie Cole. Thanks so much for listening.