A lost set of keys … missed dental appointment … forgetting the name of an acquaintance, these may be signs of normal aging. Coupled with other symptoms, however, they may also signal the start of dementia or other conditions that early-on could be mistaken for dementia—amyotrophic lateral sclerosis (ALS), depression, Parkinson’s disease or even a small stroke.
These “neurocognitive conditions” all affect a person’s ability to think and reason. They also can’t be diagnosed with a simple blood test or during a 30-minute doctor’s appointment. Accurately diagnosing a neurocognitive condition requires a comprehensive evaluation by a multi-disciplinary team of healthcare experts.
Thanks to Dignity Health, Yavapai Regional Medical Group, that important service is now available in our community. The Cognitive Assessment and Support Clinic – the first of its kind in northern Arizona – was launched August 4, 2021. The new Clinic brings together the expert team needed to conduct comprehensive cognitive (brain) assessments all under one roof.
Why a Cognitive Assessment and Support Clinic?
Sam Downing, MD, Director of Geriatrics and Palliative Medicine at Dignity Health, Yavapai Regional Medical Group, is leading the team that developed the Cognitive Assessment and Support Clinic. The Cognitive Assessment and Support Clinic fills an important community need for our aging population. In Yavapai County, approximately 32 percent of the population is 65 years of age or older, according to the Centers for Disease Control and Prevention. That’s significantly higher than Arizona’s statewide average of 18 percent.
In addition to supporting the needs of an aging population, the Cognitive Assessment and Support Clinic also reflects a new approach to cognitive health in the healthcare community.
“We know that people can suffer from different kinds of organ failure,” explains Dr. Downing. “Heart failure occurs if the heart isn’t pumping as effectively as it should. Some people experience liver failure or kidney failure. So, it makes sense that we can also experience brain failure. This is the brain’s decline over time, possibly related to aging but also possibly due to disease processes that keep the brain from functioning as it should.”
A 360-Degree Check of Your Brain Health
What does an evaluation at the Cognitive Assessment and Support Clinic include? The assessments takes place during a 3-hour appointment and feature an array of tests, screenings and exams, including:
- Neurocognitive test – This exam is conducted by a neuropsychologist—an expert at the relationship between the brain, behavior and cognitive function in multiple areas including memory, orientation, language, and executive functioning.
“A major benefit of the neurocognitive exam is that it serves as a baseline to measure any future changes in brain function,” Dr. Downing says.
- Physical exam – A primary care physician conducts a physical exam and recommends screenings and tests the patient needs. This physical may identify causes for memory issues unrelated to dementia, such as lack of vitamin B-12, other medical issues or mental health conditions.
“The Cognitive Assessment and Support Clinic team will work with partners in the community on behalf of patients,” says Dr. Downing. “If we identify an issue like depression, for example, we’ll reach out to local mental health partners – psychologists and counseling colleagues – to arrange assistance for the patient.”
- Medication evaluation – The risks, benefits, side effects and interactions of the patient’s medications – from over-the-counter to prescription – are reviewed by a clinical pharmacist.
“Often, we find that seniors are not only taking way too many medicines, but many are confused about how to take their medications correctly,” notes Dr. Downing. “The Cognitive Assessment and Support Clinic is a great opportunity to sort that out for people.”
- Social impacts – A social worker talks to the patient and family about their current living situation: work status, means of transportation, financial management and more.
“This portion of the cognitive assessment is especially helpful for families and caregivers, who unfortunately are often overlooked,” Dr. Downing says. “Our social worker will identify people who need additional support at home and recommends valuable resources.”
- Functional assessment – A check of the patient for balance problems and any difficulty with walking as these issues pose an obvious safety risk and are also an indicator of certain neurocognitive conditions.
- Nutritional assessment – The link between diet and brain health has been established by extensive research. The assessment includes a clinical review of the patient’s diet and how diet can support brain health.
- Sensory evaluation – Vision and hearing loss are part of aging, but when unaddressed they can affect the brain, lead to social isolation, and even contribute to dementia.
“Early Alzheimer’s disease is often associated with a loss of smell,” Dr. Downing says. “That’s one reason a sensory screening is important to a cognitive assessment.”
Following an evaluation at the Cognitive Assessment and Support Clinic, patients and the providers they designate will receive a report of the team’s findings. The report will include specific recommendations for follow up.
“In my work, I’ve found that as people age, they want to be fully engaged in life both physically and mentally,” Dr. Downing says. “They want a quality of life that endures. Supporting that goal is the overarching purpose of the Cognitive Assessment and Support Clinic.”
To learn more about the Cognitive Assessment and Support Clinic, and other YRMC Geriatric Services, contact Geriatric Services at Dignity Health, Yavapai Regional Medical Group, at (928) 775-5567.
Sam Downing, MD
Director of Geriatrics and Palliative Medicine
Dignity Health, Yavapai Regional Medical Group
Submitted by Dignity Health, Yavapai Regional Medical Group