Supporting people with cognitive decline—and the future of the memory clinic

Every time you make a meal, pay your bills or drive to an appointment, you're using your cognition. Your cognition—which involves learning, remembering and making judgments—helps you know how to complete these tasks and remember to do them in the first place.

As you get older, some of your cognition can diminish. This is called cognitive decline, and it can range from losing things frequently to forgetting appointments to having difficulties preparing meals. Any level of cognitive decline can impact your overall well-being and quality of life.

Bushra Malik, MD, a neurologist at Main Line Health, helps detect cognitive decline in people so they can get the treatment they need. She is playing an integral role in opening what will be a dedicated memory clinic at Main Line Health.

"At Main Line Health, we've treated people with cognitive decline for some time, but this will be the first time that we will start a dedicated memory center for our community with cognitive concerns," explains Dr. Malik. "Our memory clinic will evaluate people with cognitive deficits and help identify neurological causes behind memory challenges."

While an official memory clinic is still being developed, this already robust program will expand its services for people with cognitive decline from diagnosis to resources and ongoing support. Here's how.

Diagnosing cognitive decline at Main Line Health

Your cognition impacts almost everything you do, whether it's eating, getting dressed or talking with your friends. As a result, even minor cognitive decline can have a major impact on your quality of life.

At Main Line Health, Dr. Malik works with people with mild cognitive deficits (memory or thinking problems that are more severe than other people of the same age) and progressive dementia (memory and thinking problems that get worse over time).

The first step in treating cognitive decline is determining if and to what extent someone is experiencing this condition. Dr. Malik and other Main Line Health providers use Montreal Cognitive Assessment testing with people, which is a widely used and effective tool to assess cognitive impairment. This, along with a complete medical and family history, helps Dr. Malik make a diagnosis.

"Once the history taking and Montreal cognitive testing is complete, we will sit down with the patient and family to formulate a diagnosis and plan of care," she explains.

The process takes about an hour and a half, and Dr. Malik recommends bringing in a family member who can help with paperwork and medical history.

"If the diagnosis is unclear, our clinic will provide referrals to a neuropsychologist for evaluation of cognitive impairment," she says.

Getting people with cognitive decline the support they need

People who are experiencing cognitive decline can have trouble completing daily tasks. This can impact their ability to take care of themselves and their homes.

This is where Dr. Malik and the memory clinic come in. "Our goal is to provide necessary information to our patients and their family to understand their cognitive deficit. We'll also help them find resources within the community to help them with their needs," says Dr. Malik.

Support can include:

• Occupational therapy to help with balance, mobility and safety at home
• Social work to help with long-term care at home or in a facility
• Driving evaluations to determine if a patient is fit for driving

Helping people get the support they need is a team effort.

"We have medical assistants helping with cognitive assessment testing, experienced nurse practitioners and neurologists trained in treating people with cognitive concerns," Dr. Malik says. "Once the diagnosis has been confirmed, we'll refer patients to other specialists, such as psychologists, psychiatrists, occupational therapists and social workers when and if needed."

Dr. Malik also works closely with primary care providers and geriatricians to formulate diagnoses and generate care plans.

Helping people with cognitive decline reclaim their independence

Dr. Malik and the growing memory clinic are dedicated to helping people with cognitive decline get the support they need so they can reclaim as much independence as possible.

In fact, this is what Dr. Malik enjoys most about her job. "We recently had a patient that was living on her own with progressive dementia. Once we established a diagnosis, we formulated a plan to get a social worker involved to get her more help at home, as she was living by herself and was not able to take care of herself on her own," she explains.

"Our social worker provided essential care by providing the family and patient with services to get this patient help with activities of daily living, such as meals and services that take her to her doctor's appointments. This allows her to still live at home."

According to Dr. Malik, helping people and families understand their diagnosis and make a plan is key to success.

"Dementia diagnosis can be very overwhelming for the patient and caregivers," she says. "I enjoy meeting my people and their families, answering their questions, helping them understand their diagnosis and working with them as they progress through their disease."

Awareness and education aren't limited to current patients and families, though. "If we can educate our community and our families about dementia and the progression of this disease, we can definitely help improve the quality of our people and their families' lives," explains Dr. Malik.

While an official memory clinic is still in its early stages, Main Line Health people have been benefitting from the support of Dr. Malik and her team for some time now. As the program continues to grow, so will the extent of its reach to new people—an opportunity that Dr. Malik looks forward to being a part of.

Next steps:

Make an appointment with Bushra Malik, MD
Learn more about neurology care at Main Line Health
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