Dementia, Alzheimer’s Disease, and Mild Cognitive Impairment

Mild cognitive impairment describes changes in memory and thinking that are noticeable but not significant enough to affect daily function. In some people, changes in memory and thinking worsen over time.

Dementia describes progressive changes in memory and thinking that are severe enough to affect day-to-day activities, like managing medications and finances. The most common cause of dementia is Alzheimer’s disease. Other causes of dementia include Lewy body disease and frontotemporal dementia.

Alzheimer’s disease is characterized by declining memory, thinking, and social skills that affect a person's ability to function. Alzheimer's is the only cause of dementia for which some treatments can slow symptom progression.

Our goal is to identify the cause of your memory and thinking changes and build a treatment plan to address your symptoms. At your consultation visit: 

• A memory specialist will ask questions about your medical and family history. You’ll be asked to complete questionnaires before your appointment.
• A standard neurological exam will help us learn more about how well your brain, nerves, reflexes, and senses function.
• We will administer a brief cognitive evaluation. This series of questions and exercises helps us evaluate your capabilities and problem areas.
• Finally, your memory specialist will discuss next steps, treatment options, and research opportunities.

After your visit, we will share your test results with your primary care provider or another referring provider who will manage your treatment.

Some people may require additional tests to determine the cause of symptoms.

Brain Imaging
MRI or CT scans create high-quality images of the brain to detect abnormalities. While MRI and CT scans can provide valuable information about the brain, they cannot establish a diagnosis of Alzheimer’s disease.

Amyloid PET Scan 
An amyloid PET scan is a specialized imaging test like an MRI or CT scan. Before the scan, you'll receive medication through an IV, which binds to an abnormal protein called amyloid beta. These abnormal proteins build up in the brains of people with Alzheimer’s disease.

Cerebrospinal Fluid (CSF) Testing
Analyzing a sample of your cerebrospinal fluid (a watery liquid surrounding the brain and spinal cord) can help determine whether memory and thinking changes are due to Alzheimer’s disease.

Skin Biopsy
A sample of skin is removed and inspected under a microscope to look for abnormal proteins that build up in people with Lewy body disease, Parkinson’s, and other related diseases.

Genetic Testing
Testing for changes in specific genes can determine a person’s risk of developing Alzheimer’s disease. It can also help diagnose less common causes of memory and thinking changes like frontotemporal dementia.

While there is no cure for Alzheimer’s disease or dementia, a memory specialist will recommend a treatment plan that aligns with your goals and aims to improve your quality of life.

Medications
Medicines can help with memory and thinking changes. Before prescribing new medications, we review your existing medications and identify any potential problems or side effects. 

• New medications that target amyloid (abnormal protein deposits) -- including lecanemab (Leqembi®) and donanemab (Kisunla™) -- can slow symptom progression in people with early Alzheimer’s disease. 
   
• Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and memantine (Namenda) may help maintain memory, thinking, and allow people to function more independently.

Physical Therapy and Occupational Therapy
Specialized therapists help promote health and wellness, increase strength, prevent falls, and enable you or your loved one to maintain as much independence as possible.

Speech Therapy and Communication Support 
Speech-language pathologists help improve communication by providing practical, functional, and personalized strategies to overcome barriers.

Lifestyle Changes
Eating a brain-healthy diet, exercising, getting restorative sleep, and remaining cognitively and socially engaged can help maintain memory and thinking.

Team Approach
At Duke, you’ll be cared for by experts in neurology, geriatric psychiatry, and geriatric medicine with additional training and expertise in memory care. Our team includes doctors, physician assistants, nurses, social workers, research coordinators, and pharmacy experts who work together for your benefit.

Access to Breakthrough Research
Duke experts have made important contributions to the scientific understanding of memory and thinking changes. Duke experts were the first to discover that variants in a specific gene called APOE increase the risk of developing Alzheimer’s disease.

We have many ongoing research studies and clinical trials to help us better understand, diagnose, and treat diseases like Alzheimer’s that affect memory and thinking.