If you or a loved one has been experiencing a slight but noticeable decline in memory or thinking skills with age, mild cognitive impairment (MCI) may be to blame. Affecting about 15%-20% of adults aged 65 or older, MCI puts individuals at an increased risk of developing Alzheimer’s disease or a different type of dementia. This impairment is enough to be noticed by family and friends, but not enough to negatively influence the individual’s daily life. MCI can either be amnestic or nonamnestic, with the former negatively affecting memory of appointments and recent events and the latter negatively affecting decision-making or ability to piece together steps to complete a task.
If MCI is diagnosed early and treatment is started, the progression to these conditions may be delayed. This is the goal of the innovative Interdisciplinary Memory Assessment Program (IMAP) clinic at the Froedtert & the Medical College of Wisconsin Froedtert Hospital.
“Mild cognitive impairment is the transitional stage between normal aging and any kind of dementia,” says Malgorzata Franczak, MD, neurology professor and neurologist within the IMAP clinic. “We want to diagnose these patients before they progress to dementia so we can offer them pharmacological and nonpharmacological treatment and the opportunity to participate in clinical trials.”
What Differentiates the IMAP Clinic?
This neurology-led program is the first of its kind in Wisconsin and has been seeing patients since 2017. The IMAP clinic offers patients and their families an intensive two-hour visit where they will meet with a behavioral neurologist, neuropsychologist and a social worker to review cognitive concerns in hopes that a diagnosis can be made and a treatment plan can be discussed at the end of the visit.
“Historically, a patient would get referred to neurology and neuropsychology separately,” Dr. Franczak said. “It would sometimes take weeks — or even months — before being seen by either specialty, and then they’d also have to wait weeks to obtain feedback from a behavioral neurologist. Our neurology department brainstormed and decided to combine these two services, as well as social work, to provide optimal care for patients and their families.”
Inside an IMAP Clinic Visit
Patients are usually referred to the IMAP clinic by their primary care provider who may notice some beginning stages of cognitive impairment. The patient and their family then receive a phone call by a dedicated IMAP clinic nurse two weeks prior to their scheduled visit. During this intake phone call, the nurse collects the following information from the patient:
- Chief complaint
- Health history
- Current self-assessment of their cognitive abilities, behavioral issues and any functional limitations
- Current medication list
- Family history of any mental illness
It is also required that the nurse speaks to a care partner, caregiver or family member who knows the patient well enough to confirm the patient and family’s concerns.
On the day of the IMAP visit, the patient and family begin together and meet with a behavioral neurologist and a Ph.D.-level neuropsychologist to discuss anything that wasn’t covered during the intake phone call. The patient then participates in neuropsychological testing for about an hour. This standardized testing assesses the patient’s cognitive domains, including memory, language, executive, visuospatial skills and others depending on the patient and family’s concerns. For example, short-term, long-term and recall memory are tested by repeating recently heard words and naming as many animals as they can in a minute.
”Impairment of short term memory, known as episodic memory, is often the first symptom seen in the early stages for Alzheimer’s disease,” Dr. Franczak said.
While the patient is completing these tests, the family meets with the IMAP clinic’s social worker. The topic and discussion’s intensity level depends greatly on the patient’s level of cognitive ability. The social worker is more involved if the patient is in a more advanced stage of their MCI or is showing signs of mild Alzheimer’s disease. In this instance, the family will be given education on the disease and be connected to support groups, adult day camp centers or any other psychosocial resource the patient may need.
“These connections are a huge help for patients’ care partners because many times they feel helpless or don’t know the next step once their loved one is diagnosed,” Dr. Franczak said. “Medications are very limited in what they do for these diseases. There are currently no medications approved for treatment of MCI, and those that are approved for Alzheimer’s disease have a modest effect on its progression, at most. The connections between other patients and families with mild cognitive impairment and the cognitive stimulation that comes from that is huge.”
Following the testing and social worker meeting, all involved staff — behavioral neurologist, neuropsychologist, psychometrician who administers the testing and the social worker — meet to discuss the patient and come up with a consensus diagnosis. The patient and family are then reunited and given the diagnosis and treatment guidelines. The IMAP clinic is able to provide about 90% of patients and families with a diagnosis, treatment plan and follow up visit, which is usually with the neurology department.
MCI Diagnosis and Recommended Treatments
The most common diagnosis is amnestic MCI, which progresses toward Alzheimer’s disease. According to the National Institute on Aging, people with amnestic MCI may lose things frequently, have trouble remembering appointments, or have a hard time coming up with words when talking compared to other people their same age.
The IMAP clinic’s treatment guidelines for these patients are based on their baseline functional status and involve corresponding cognitive stimulation. The patient is encouraged to continue to do the things they enjoy doing, even if they aren’t at their best doing it. This can be golfing, crocheting, playing cards, doing puzzles or drawing, for example. If a patient doesn’t have a hobby or interest, they are asked to work on some beginner level sudoku or crossword puzzles, sometimes with the help of their families, to keep their mind sharp.
“I always tell patients to use it or lose it,” Dr. Franczak said. “If you don’t use your brain, you will lose your brain and there’s nothing that anybody or any medication can do. It’s really what the patient does with his or her brain in terms of cognitive stimulation that defines the trajectory of the disease in terms of progression.”
The IMAP clinic is located within the neurology department at Froedtert Hospital and is currently accepting new patients. If you’re worried about your memory, have a family history of Alzheimer’s disease or dementia or would like to see if you’re a fit for the IMAP clinic, call 414-805-3666 or request an appointment online.
“No other memory disorder program has the luxury of having a behavioral neurologist, neuropsychologist, and a social worker at every single visit,” Dr. Franczak said. “This really is a multidisciplinary approach to patients and their families, which is not a common practice whatsoever.”
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My mom is 94 and experiencing what you have described. Plus she has major hearing loss. Would something like this benefit her at all?
Hi Kathee - Given your mother’s age and her hearing loss, which can be a confounding factor to her cognitive problems as well as her ability to perform one hour of cognitive testing, we do not think that IMAP clinic would be best for her. Patients who are older than 89 years of age might be best served by geriatric clinic.
I am very interested in this - my husband has MS - Diabetes and at last testing about 5 years ago at Froedtert they said he had shrinkage on the frontal lobes - many changes since than - extreme sleeping and sometimes extreme behavior problems - but we are on a fixed income retired - will Medicare cover the cost of this.
Hi Sharon - Patients with MS are known to develop cognitive changes involving frontal lobes. These changes often manifest as dysexecutive syndrome with behavioral/personality changes as you described. Your husband would probably not benefit from the IMAP clinic but might benefit from another neuropsychological evaluation to determine if there has been any further cognitive decline.