How Can a Memory Clinic Be of Help
Dr. Ellison discusses how a memory clinic can be of help.
Featuring:
Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
James Ellison, MD MPH
Dr. Ellison was born in Minnesota and raised mostly in California, but higher education opportunities lured him to Boston, where he trained to be a psychiatrist at the Massachusetts General Hospital, Subsequently, he spent several decades working as a general and geriatric psychiatrist in several hospitals in or near Boston. He also received a Master of Public Health degree from the Harvard School of Public Health. Throughout his career, he has developed and led clinical and research programs while also promoting education of the public and of his professional peers. He has worked in diverse settings including emergency psychiatry services, inpatient and outpatient clinical settings, managed care, and private practice. Since 1999, he has focused on mental health issues of older adults.Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
Transcription:
Melanie Cole: This is ChristianaCares, Swank Memory Care Podcast Series. I'm Melanie Cole and today we're talking about how a memory clinic can be of help. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank Foundation Endowed Chair in Memory Care and Geriatrics at ChristianaCare. Dr. Ellison, it's a pleasure to have you join us again today. What is a memory clinic? Tell us.
Dr. Ellison: A memory clinic is an outpatient service and it can be designed in lots of different ways, but the overall idea is to provide consultation to primary care and to individuals and families who are concerned about their cognitive health. We call it a memory clinic because most of the people who call us up say that they're having trouble remembering things, but in the clinic we're able to evaluate in a much finer way the different elements of cognitive functioning that lead into memory complaints. So, for example, a person might have attention problems or they might have difficulty with spatial representations or with language, and all of those things can show up as concerns about memory. If a person can't find the right word, they may feel that it's a memory problem or if they lose their way they might attribute it to a memory difficulty, but it can be more complex than that.
Host: Well, so then when I suppose is, is the question, when would someone be referred to a memory clinic? What would have to necessitate that kind of referral?
Dr. Ellison: You and I have discussed some topics in dementia previously and when we've talked about dementia, one of the important points that comes up is that we don't have a definitive cure yet for dementia. But one of the things that we can do is prevention. So in a memory clinic, we like to see people who are at an early stage of memory difficulty because we can advise them about the nature of their problem, whether there are any treatable medical conditions that might assist them and what kind of lifestyle changes they can make to improve their cognitive functioning.
Host: So tell us about what that looks like for patients and even for their families. Dr. Ellison, are the families involved in these clinics? Tell us what it looks like for the patient and what these clinics are like.
Dr. Ellison: Many people who have cognitive difficulties, lack awareness that they have those kinds of problems. So for example, you might have an older relative who asks you the same question repeatedly and it seems like they're not paying attention or listening to your answer, but in reality, they're listening. They're not making a new memory. Or you might notice that an older relative of yours has some trouble keeping track of appointments. Remembering to be where they're supposed to be, remembering a conversation they had recently or they might be leaving the door unlocked inappropriately or having safety issues around the house with the stove. Those are all reasons why a person should be referred to a memory disorders clinic. They may choose first to go to a primary care clinician and have some preliminary evaluation, but in the long run, a memory clinic can provide some expert assessment of the causes of the memory problem and also characterize what's going on and recommend a course of management that may be helpful in preventing further decline or slowing it down.
Host: Dr. Ellison, when patients come to the clinic, have you seen in your experience that they are resistant because they're afraid that if they attend a clinic like this, they'll lose their driver's license or they won't see their primary care provider or any of these kinds of worries they might have about attending a clinic?
Dr. Ellison: Yes. One of the biggest concerns that faces older adults. One of the biggest fears is concern about losing memory and that's a very reasonable fear because up to 40% of people by age 85 have significant memory difficulties. So this is a common problem as we age and it ranges from kind of normal forgetfulness and cognitive changes that are normal for aging to full blown dementia where a person loses their independence, it's natural that a person worries about losing their memory and so they get very frightened if somebody points out to them that they may be having problems more than would be expected for age. We see this of course when they come to the memory clinic and one of the most important things that we can do is reassure people who have normal memory aging that this is not a disease process and we don't expect it to become a disabling process.
That's a real advantage of getting an evaluation that can assess what kind and what degree of cognitive difficulty there is. Now, some of the people who come to our clinic also worry about the kind of implications that a diagnosis of mild cognitive impairment or another neurocognitive disorder might have on their life. For example, if they haven't already applied for long-term care insurance, a diagnosis of a neurocognitive disorder on their medical record could interfere with their getting that. So it's best to take care of that when you're healthy and before any problem has developed. There also is the concern that some older adults have that if they go to the memory clinic, their driver's license will be taken away or their driving privileges will be curtailed. So let me say a word about that. One of the types of evaluations that we're concerned about in a memory disorders clinic is evaluating home safety and driving safety. So we'll typically ask a person whether they've had any fender benders or scrapes, whether they've run red lights or had difficulty finding their way when they're driving.
And if a caregiver or relative is with them, we'll often ask whether that person has driven with them. Unfortunately with severe cognitive impairment, most drivers don't stop driving until they have a significant motor vehicle accident. That's the event that usually ends a person's driving career with severe cognitive difficulty for their safety, for the safety of the patient and for the safety of public. We want to make sure that we help people honestly and frankly assess their driving safety and make an informed decision about whether it's appropriate for them to continue driving or make different transportation arrangements, but be assured that nobody in a memory clinic ever takes away a person's license or tells them they can't drive. What we might tell them if it's appropriate, is that they should have a driving evaluation on the road only really with a driving evaluation and a normal test for driving knowledge. Can driving safety be truly assessed in an accurate way. The tests that we do in a memory clinic merely help us suggest whether a further driving evaluation at the Department of Motor Vehicles or a driver rehabilitation specialist tester is appropriate.
Host: Before we wrap up, tell us some of the types of therapy that might be available. If you do discover mild cognitive impairment or even just age related memory issues that some people experience, what can you do for them? What are the types of therapy available?
Dr. Ellison: There is no medication that reverses memory changes and there's no particular type of medical therapy that we know of that can bring back age associated memory loss. However, there are a number of lifestyle interventions that can be very helpful, so we often talk with our patients about physical activity. We talk with them about nutrition and appropriate diet habits and weight control. We talk with them about getting enough sleep, exercising their mind, remaining involved with a sense of purpose and connecting with other people, and these are things that can help a person age cognitively in a healthier way. In addition to that, in a memory clinic, we would assess a person's medications and try and understand whether they're taking any medicine that be harmful to their cognitive functioning and we would work with their primary care clinician to reach a better plan for their medications.
We wouldn't take control of their medications, so much as we would collaborate with a care team in order to make their medications more helpful and appropriate. Then we also assess things, sleep disorders, medical disorders, substance use and all of those things help us understand where there might be medical interventions that would help a person age cognitively in a healthier way. And then finally, there are significant numbers of people in the older adult population who suffer from generalized anxiety or from some other anxiety disorder or from mild to moderate depression. And these behavioral health disorders can really affect cognitive functioning and interfere with memory. So we like to identify that and make sure that a person receives appropriate treatment.
Host: Then offer your advice. Dr. Ellison, because you are such an expert in this, what do memory clinics contribute to the overall context of care for the aging population? Tell us what you'd like us to know about memory clinics in general and specifically the Swank Memory Center.
Dr. Ellison: The Swank Memory Center and others, similar memory clinics. And there are a number of these around the country are often multidisciplinary teams of outpatient clinicians who work in a variety of disciplines, neurology, primary care, behavioral health, nursing, neuropsychology, and social work, all can be part of this kind of this team. With a multidisciplinary team that has expertise in assessing, recognizing, and managing neurocognitive disorders. The memory clinic can contribute to a person's overall health and healthy aging by collaborating with their primary care treatment team to develop a good plan for health and lifestyle.
Host: Thank you so much Dr. Ellison for joining us and sharing your incredible expertise today and that concludes this episode of ChristianaCare, Swank Memory Care Podcast Series. To learn more about programs or services or to schedule an evaluation at the Swank Memory Center, Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders, you can call (302) 320-2620. Or you can visit Christianacare.org/SwankMemoryCare for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other ChristianaCare podcasts. I'm Melanie Cole.
Melanie Cole: This is ChristianaCares, Swank Memory Care Podcast Series. I'm Melanie Cole and today we're talking about how a memory clinic can be of help. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank Foundation Endowed Chair in Memory Care and Geriatrics at ChristianaCare. Dr. Ellison, it's a pleasure to have you join us again today. What is a memory clinic? Tell us.
Dr. Ellison: A memory clinic is an outpatient service and it can be designed in lots of different ways, but the overall idea is to provide consultation to primary care and to individuals and families who are concerned about their cognitive health. We call it a memory clinic because most of the people who call us up say that they're having trouble remembering things, but in the clinic we're able to evaluate in a much finer way the different elements of cognitive functioning that lead into memory complaints. So, for example, a person might have attention problems or they might have difficulty with spatial representations or with language, and all of those things can show up as concerns about memory. If a person can't find the right word, they may feel that it's a memory problem or if they lose their way they might attribute it to a memory difficulty, but it can be more complex than that.
Host: Well, so then when I suppose is, is the question, when would someone be referred to a memory clinic? What would have to necessitate that kind of referral?
Dr. Ellison: You and I have discussed some topics in dementia previously and when we've talked about dementia, one of the important points that comes up is that we don't have a definitive cure yet for dementia. But one of the things that we can do is prevention. So in a memory clinic, we like to see people who are at an early stage of memory difficulty because we can advise them about the nature of their problem, whether there are any treatable medical conditions that might assist them and what kind of lifestyle changes they can make to improve their cognitive functioning.
Host: So tell us about what that looks like for patients and even for their families. Dr. Ellison, are the families involved in these clinics? Tell us what it looks like for the patient and what these clinics are like.
Dr. Ellison: Many people who have cognitive difficulties, lack awareness that they have those kinds of problems. So for example, you might have an older relative who asks you the same question repeatedly and it seems like they're not paying attention or listening to your answer, but in reality, they're listening. They're not making a new memory. Or you might notice that an older relative of yours has some trouble keeping track of appointments. Remembering to be where they're supposed to be, remembering a conversation they had recently or they might be leaving the door unlocked inappropriately or having safety issues around the house with the stove. Those are all reasons why a person should be referred to a memory disorders clinic. They may choose first to go to a primary care clinician and have some preliminary evaluation, but in the long run, a memory clinic can provide some expert assessment of the causes of the memory problem and also characterize what's going on and recommend a course of management that may be helpful in preventing further decline or slowing it down.
Host: Dr. Ellison, when patients come to the clinic, have you seen in your experience that they are resistant because they're afraid that if they attend a clinic like this, they'll lose their driver's license or they won't see their primary care provider or any of these kinds of worries they might have about attending a clinic?
Dr. Ellison: Yes. One of the biggest concerns that faces older adults. One of the biggest fears is concern about losing memory and that's a very reasonable fear because up to 40% of people by age 85 have significant memory difficulties. So this is a common problem as we age and it ranges from kind of normal forgetfulness and cognitive changes that are normal for aging to full blown dementia where a person loses their independence, it's natural that a person worries about losing their memory and so they get very frightened if somebody points out to them that they may be having problems more than would be expected for age. We see this of course when they come to the memory clinic and one of the most important things that we can do is reassure people who have normal memory aging that this is not a disease process and we don't expect it to become a disabling process.
That's a real advantage of getting an evaluation that can assess what kind and what degree of cognitive difficulty there is. Now, some of the people who come to our clinic also worry about the kind of implications that a diagnosis of mild cognitive impairment or another neurocognitive disorder might have on their life. For example, if they haven't already applied for long-term care insurance, a diagnosis of a neurocognitive disorder on their medical record could interfere with their getting that. So it's best to take care of that when you're healthy and before any problem has developed. There also is the concern that some older adults have that if they go to the memory clinic, their driver's license will be taken away or their driving privileges will be curtailed. So let me say a word about that. One of the types of evaluations that we're concerned about in a memory disorders clinic is evaluating home safety and driving safety. So we'll typically ask a person whether they've had any fender benders or scrapes, whether they've run red lights or had difficulty finding their way when they're driving.
And if a caregiver or relative is with them, we'll often ask whether that person has driven with them. Unfortunately with severe cognitive impairment, most drivers don't stop driving until they have a significant motor vehicle accident. That's the event that usually ends a person's driving career with severe cognitive difficulty for their safety, for the safety of the patient and for the safety of public. We want to make sure that we help people honestly and frankly assess their driving safety and make an informed decision about whether it's appropriate for them to continue driving or make different transportation arrangements, but be assured that nobody in a memory clinic ever takes away a person's license or tells them they can't drive. What we might tell them if it's appropriate, is that they should have a driving evaluation on the road only really with a driving evaluation and a normal test for driving knowledge. Can driving safety be truly assessed in an accurate way. The tests that we do in a memory clinic merely help us suggest whether a further driving evaluation at the Department of Motor Vehicles or a driver rehabilitation specialist tester is appropriate.
Host: Before we wrap up, tell us some of the types of therapy that might be available. If you do discover mild cognitive impairment or even just age related memory issues that some people experience, what can you do for them? What are the types of therapy available?
Dr. Ellison: There is no medication that reverses memory changes and there's no particular type of medical therapy that we know of that can bring back age associated memory loss. However, there are a number of lifestyle interventions that can be very helpful, so we often talk with our patients about physical activity. We talk with them about nutrition and appropriate diet habits and weight control. We talk with them about getting enough sleep, exercising their mind, remaining involved with a sense of purpose and connecting with other people, and these are things that can help a person age cognitively in a healthier way. In addition to that, in a memory clinic, we would assess a person's medications and try and understand whether they're taking any medicine that be harmful to their cognitive functioning and we would work with their primary care clinician to reach a better plan for their medications.
We wouldn't take control of their medications, so much as we would collaborate with a care team in order to make their medications more helpful and appropriate. Then we also assess things, sleep disorders, medical disorders, substance use and all of those things help us understand where there might be medical interventions that would help a person age cognitively in a healthier way. And then finally, there are significant numbers of people in the older adult population who suffer from generalized anxiety or from some other anxiety disorder or from mild to moderate depression. And these behavioral health disorders can really affect cognitive functioning and interfere with memory. So we like to identify that and make sure that a person receives appropriate treatment.
Host: Then offer your advice. Dr. Ellison, because you are such an expert in this, what do memory clinics contribute to the overall context of care for the aging population? Tell us what you'd like us to know about memory clinics in general and specifically the Swank Memory Center.
Dr. Ellison: The Swank Memory Center and others, similar memory clinics. And there are a number of these around the country are often multidisciplinary teams of outpatient clinicians who work in a variety of disciplines, neurology, primary care, behavioral health, nursing, neuropsychology, and social work, all can be part of this kind of this team. With a multidisciplinary team that has expertise in assessing, recognizing, and managing neurocognitive disorders. The memory clinic can contribute to a person's overall health and healthy aging by collaborating with their primary care treatment team to develop a good plan for health and lifestyle.
Host: Thank you so much Dr. Ellison for joining us and sharing your incredible expertise today and that concludes this episode of ChristianaCare, Swank Memory Care Podcast Series. To learn more about programs or services or to schedule an evaluation at the Swank Memory Center, Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders, you can call (302) 320-2620. Or you can visit Christianacare.org/SwankMemoryCare for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other ChristianaCare podcasts. I'm Melanie Cole.