St. Luke’s Medical Center - Global City
Institute for Neurosciences
The St. Luke’s Medical Center Memory Service was created to address the needs of individuals with changes in memory and thinking. The service caters to adults who have concerns of changes in memory, thinking and/or behavior. It offers a comprehensive cognitive assessment to aid in the diagnosis of cognitive impairment which has many causes. These include stroke, neurodegenerative diseases like Alzheimer’s disease dementia, traumatic brain injury, neuropsychiatric conditions and other less common diseases.
Globally, there are currently estimated to be over 50 million people living with dementia. This number is expected to increase to 152 million by 2050, with the greatest rise in low and middle income countries. At present, 60% of people with dementia live in low and middle income countries like the Philippines. Every 3 seconds, a new case of dementia is diagnosed somewhere in the world. However, up to three quarters of those with dementia worldwide have not received a diagnosis.1
Early diagnosis of cognitive impairment is important because it allows prompt access to treatment. Early initiation of treatment can help maintain quality of life and daily function and in some cases may prevent the progression of mild cognitive impairment to dementia. An ideal treatment plan consists of a multi-domain approach, both pharmacological and non-pharmacological, that addresses biological or medical, psychological, social, and environmental factors.2
The Memory Service uses a multi-disciplinary approach in responding to the needs of individuals with changes in memory, thinking and behavior. The Memory Service consists of neurologists, neuropsychiatrists, psychiatrists, clinical psychologists, occupational therapists, speech and language pathologists, and nurses who are all trained in and are dedicated to caring for individuals with cognitive and behavioral concerns. It offers the following services.
The assessment involves psychometric tests administered by a board-certified clinical psychologist followed by a thorough history and neurologic examination performed by a board-certified neurologist. A collateral source is also needed for history-taking. The tests identify particular cognitive domains that are impaired in cognitive impairment or dementia syndromes such as: language, learning and memory, visuospatial and constructional praxis, and attention and executive functions. A person’s scores on the psychometric tests are compared against normative values based on age and educational background. A cognitive assessment can also be repeated after six months or annually as needed for longitudinal evaluation. Improvements or decline in performance can then be tracked over time.3
This is an evaluation of a person’s intelligence, cognition, behavior and functionality for fit to work or study clearance, for immigration purposes, and pre-operative baseline screening.
This program uses evidence-based interventions to improve cognition and learn coping strategies in individuals with cognitive impairment due to various conditions. The goals of the program are tailored to suit each individual’s needs. They can include maximizing safety, daily functioning, independence, and quality of life.
This form of therapy involves helping an individual understand how thoughts and feelings influence behavior. It has been shown to be effective in managing neuropsychiatric conditions like chronic insomnia, depression, anxiety, and others.
Difficulties in verbal and nonverbal communication may arise from various neurological conditions. This program uses evidence-based interventions to improve those communication difficulties.
This is a program designed to increase vocal intensity and maximize phonatory and respiratory functions of individuals with Parkinson’s disease.
This intervention is used for those with speech production disorders brought by various neurological conditions.
The following tests, available at St. Luke’s Medical Center, are recommended as part of the initial evaluation of cognitive impairment. These are according to international guidelines based on years of research.
A cranial MRI is recommended because it identifies structural brain diseases that can cause cognitive impairment. Some of these conditions may be urgent such as a tumor or normal pressure hydrocephalus. It may also aid in the detection of early Alzheimer’s disease by identifying characteristic medial temporal lobe atrophy.4 The cranial MRI dementia protocol at St. Luke’s Medical Center is currently the only protocol in the country that measures the hippocampal volume using the NeuroQuant(R) software and compares it against a normative database.5 This is important as visual scoring of medial temporal atrophy may have inter- and intra-rater variability. The presence of hippocampal atrophy indicates neurodegeneration and supports a diagnosis of a neurodegenerative process like Alzheimer’s disease.
This test measures the presence of amyloid in the blood. Amyloid is a protein that has been shown to be deposited in the brain of patients with AD and has also been implicated in the pathophysiology of other neurodegenerative diseases like dementia with Lewy bodies. Its value is in establishing support for the underlying etiology of the clinical syndrome in an individual with mild cognitive impairment (MCI). Establishing etiology is important in choosing the correct therapy, particularly when more effective treatments become available. It is also important in determining the likelihood of progression of cognitive and functional decline in an individual with MCI to a more severe stage of impairment or dementia and how fast this progression may occur.6
The apolipoprotein ε4 allele is a major genetic risk factor for the development of the more common and sporadic form of Late-Onset Alzheimer’s disease (LOAD). The presence of one or two ε4 alleles in the apolipoprotein gene is the only genetic variant broadly accepted as increasing risk for development of LOAD whereas the ε2 allele decreases risk. Evidence suggests that an individual who meets the clinical, cognitive, and etiologic criteria for MCI, and is also APOE ε4 positive, is more likely to progress to AD within a few years than an individual without this genetic characteristic.3
Vitamin D is a steroid vitamin that also regulates neurotransmitters and neurotrophins. It has anti-inflammatory, antioxidant, and neuroprotective properties. Longitudinal studies, cross-sectional studies and meta-analyses have shown an association of low vitamin D with cognitive impairment and AD. It is therefore important to check vitamin D levels in patients complaining of cognitive symptoms. If found to be deficient, patients are usually advised sun exposure and oral vitamin D supplementation, not just to aid in cognition but for overall health. A randomized trial showed that visual memory improved in subjects given high dose supplementation of vitamin D compared to those in the low dose group.7
Studies have shown that elevated serum homocysteine levels are inversely related to cognitive function in patients with dementia. Elevated levels are more common among individuals with vascular cognitive impairment and vascular dementia that individuals with AD. Checking for this level will help determine the etiology of cognitive impairment. If elevated, it can also be addressed by administration of methylcobalamin and folic acid. Elevated serum homocysteine is also a risk factor for cardiovascular disease and stroke, which are common comorbid conditions in our patient population.8
Thyroid disease, particularly hypothyroidism, may present as cognitive impairment in any age population but is especially important to check for in elderly individuals as other symptoms of thyroid disease may not be present. This is a treatable and reversible cause of cognitive impairment.2