Dementia

Dementia is an umbrella term that describes problems with memory, language and communication, reasoning, and other cognitive tasks. It can have many causes, but Alzheimer’s disease is the most common.

It can be frightening to suspect that you or a loved one may be experiencing memory loss or showing signs of cognitive impairment. Our specialized memory disorders experts help you navigate each step of the process, from evaluation to treatment. 

Your Consult Appointment
Our goal is to get to know you during your consultation appointment.

• A memory specialist will ask questions about your medical and family history.
• A standard neurological exam will help us learn more about how well your brain, nerves, reflexes, and senses are functioning.
• We will administer a brief cognitive evaluation. This is a series of questions and exercises that help us evaluate capabilities and problem areas.
• Finally, your memory specialist will spend time talking with you about next steps, treatment options, and research opportunities.

We work together with your primary care physician to provide an accurate diagnosis and treatment plan that your primary care team can supervise. 

Your memory specialist may request some additional tests to rule out other conditions that are rare but can cause cognitive symptoms that are similar to those seen with dementia or Alzheimer’s disease.

Imaging
MRI or CT scans create high-quality images of the brain and may detect abnormalities related to cognitive loss. 

Cerebrospinal Fluid Testing 
A procedure called a spinal tap collects cerebrospinal fluid (CSF), which can help determine whether a person has Alzheimer's disease. The procedure takes approximately 45 minutes. You are able to return home the same day, and you can resume normal activity after 48 hours.

Neuropsychological Testing
If a brief cognitive assessment doesn’t provide all of the information your memory specialist needs, they may request more in-depth neuropsychological testing to identify the extent of any impairment.

Medications
Unfortunately, there is no cure for many types of cognitive impairments, including dementia and Alzheimer’s disease. Before prescribing these medications, we’ll review all of your existing medications, identify any problems or side effects, and help you decide whether medication is the right choice for you.     

• Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and memantine (Namenda) may help slow the progression of cognitive and functional decline.     
• A new monoclonal antibody called lecanemab is an intravenous infusion given every other week. It has been shown to slow the progression of Alzheimer’s in some people in the earliest stages of the disease.

Therapies
Our memory specialists work closely with physical therapists, occupational therapists, and speech-language pathologists to administer available treatments and to improve your or your loved one’s quality of life.

• Physical and Occupational Therapy: Specialized therapists aim to promote health and wellness, increase strength, prevent falls, and enable you to maintain as much independence as possible.
• Speech Therapy and Communication Support: Speech-language pathologists focus on using each person’s strengths and reducing barriers in order to promote successful communication. We problem solve with you and your family to provide practical, functional, and personalized strategies to overcome difficult situations. We also offer a specialized eight-week program that helps you address communication breakdowns and memory issues, social isolation, or difficulty with conversations. We provide individual and group therapy for the person with cognitive impairment, and we also provide group education and support for caregivers. 

Environmental Changes
Customizing a living environment to be safe for people with memory problems is important. We help guide you through what changes might be necessary, such as adding guide rails and removing excess furniture.

Exercise and Nutrition
An integral part of our mission is wellness. Staying physically active and eating well may become more challenging for people with memory disorders. We educate you or your loved ones on how to incorporate behaviors and routines to promote restful sleep, prevent excess weight gain, avoid constipation, and stay hydrated.

Compassionate Care and Family Support
Our memory experts will provide a sound diagnosis, establish a personalized treatment plan, and patiently answer all your questions. We treat the full spectrum of cognitive impairments, including the behavioral, emotional, and physical aspects of memory disorders. Since there is no cure for dementia or Alzheimer’s disease, developing a support network is essential. The Duke Dementia Family Support Program is a comprehensive resource to help you cope, make elder care decisions, and support your loved one through what can be a very difficult time.

Access to Breakthrough Research
Our researchers are known for their work studying the family history related to Alzheimer’s disease and similar disorders. We discovered the “risk gene” -- apolipoprotein E -- the first gene variation found to increase the risk of developing Alzheimer’s. We perform many other research studies to learn more about memory loss. You or your loved one may be eligible to participate in our clinical trials, which offer access to novel therapies, including possible disease-modifying therapies or medications that affect symptoms. You may also have the opportunity to participate in research studies to help us learn more about the root cause of Alzheimer’s disease and related dementias -- your contribution to a cure. 

Team Approach
You and your loved one will have access to providers who are experts in neurology, geriatric psychiatry, and geriatric medicine and who specialize in memory care. Our team includes doctors, physician assistants, nurses, social workers, research coordinators, and pharmacy experts. 

Social Work Services
Our social workers are available to meet with you and provide resources such as patient and family educational materials. They can also share information about support groups for patients, caregivers, and families. Our social workers help patients and families cope and adjust to memory disorder diagnoses.