LONDONDERRY — Patients come from an hour away — and from as far as Florida and New York — to Elliot Health System’s Memory & Mobility Center to get to the bottom of perplexing changes such as forgetting names of flowers they’ve grown for decades, losing words poised on the tip of the tongue, and becoming lost while driving familiar routes.
Sometimes the issues are signs of aging’s gradual assaults on recall and thinking. Sometimes they’re symptoms of deep-seated progressive illness, such as Alzheimer’s disease or vascular dementia. Memory clinics help seniors sort normal aging from what is not.
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Especially now, when a steep rise in dementia cases is predicted in New Hampshire, the second-oldest state, neurologists and psychiatrists are in short supply here and nationwide — and early diagnosis is critical to extending quality of life — the memory center provides a waiting lifeboat.
A diagnosis can be obtained in six to eight weeks, instead of six to 12 months or longer, the typical wait for specialty appointments, testing and interpretation of results scheduled piece by piece.
The center, part of Elliot Hospital, may be the state’s first community-based hospital clinic, open every weekday, offering an inter-disciplinary approach to spotting memory loss and cognitive impairment. Medical, behavioral, diagnostic, and family support services and treatment are under one roof.
“Not everyone who walks through the door leaves with a diagnosis,” said Dr. Ross Gourvitz, the clinic’s neuropsychologist and director. “Forgetting keys is normal. Forgetting what keys are for is not. Tying a ribbon around your finger sounds like a funny thing — but not if you don’t remember what the ribbon is for.”
The center at 40 Buttrick Road receives roughly 17 referrals weekly from primary care providers, neurologists, behavior health professionals, family members concerned about loved ones’ safety, and patients 65 and older who refer themselves.
Since it opened in early 2014, the center has served close to 1,500, mostly seniors. The center’s staff teases out underlying causes of memory decline ranging from anxiety and depression, which drain power from other brain functions, to chronic illnesses such as diabetes and heart disease and medical conditions such as urinary tract infections and vitamin B-12 deficiencies.
“We try not to jump to conclusions based on a small piece of information,” said Lisa Donnellan, the clinic’s social worker. “We look at everything. We’re a hub for a lot of people we loop in.”
Since the 1980s, the U.S. has witnessed a steady growth in dementia and memory units in nursing homes and assisted living communities, and more recently a sprinkling of outpatient clinics attached to regional hospitals. Along with neurologists called upon to make diagnoses, community mental health centers and geriatric psychiatrists, they form the front lines for spotting and supporting older patients experiencing age-typical difficulties as well as degenerative disease.
It’s frequently hard for elders committed to living independently to see or admit their own increasing deficits.
“They’ll say, ‘My memory’s fine. I remember my prom date, the weather on my wedding day,’” Gourvitz said — not surprising since most long-term memories are engraved by emotional experience.
“It’s really a question of new learning,” said Gourvitz. People with memory problems are unable to process and retain new information. A frequently used diagnostic tool consists of reading a list of 10 words, then repeating them 15 minutes later. “For someone in their 80s, remembering one or two words is pretty normal. For someone in their 40s, that’s significant impairment.”
Donnellan evaluates patients through intake interviews, ferreting out what might be going on daily that’s concerning. How do they remember to take their medication? “What is their organization and thought process? Do they have a system that appears to be working?”– such as putting the bottle next to a place mat.
Diagnosis typically involves a neuropsychological evaluation — a test of memory, mood, visual skills, attention and concentration, language ability, and executive function — including planning, sequencing, judgment, and the ability to carry out a multiple-step procedure such as climbing a ladder to clear snow off the roof, remembering to leave the front door unlocked, and getting safely back down again. Even for someone who’s done that for 40 years, erosion of executive function can make that time-honored chore impossible.
The Memory and Mobility Center uses a patient-centered approach that means getting to know patients personally and tracking changes at regular intervals.
Treatment often involves learning compensation strategies such as setting watch and cell phone alarms to signal medication times, making lists of daily activities in order, posting sticky notes on mirrors and refrigerator doors, and establishing a routine that is comforting and predictable.
“Older folks may have to stop and process the information a little differently than a 20-something,” Donnellan said. “It doesn’t mean they can’t do it. They just have to do it differently.”