Memory problems can show up early in 'mini cog' screenings

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Upstate Medical University and Syracuse University have teamed up to assess the benefit of memory screenings. And here to tell us more about this partnership is Dr. Sharon Brangman. She's a SUNY Distinguished Service professor, the chair of geriatrics, and the director of the Center of Excellence for Alzheimer's Disease at Upstate. Welcome back to "The Informed Patient," Dr. Brangman.

[00:00:37] Sharon Brangman, MD: Oh, thanks for having me.

[00:00:39] Host Amber Smith: Do I understand correctly that some residents can participate in this collaborative project and get a free memory screening?

[00:00:47] Sharon Brangman, MD: So yes. What we've done is we've collaborated with the New York State Office for Aging, and we're focusing on seven counties. And as part of their normal client intake, we trained some of these workers to perform a quick mini cognitive screen.

So it's not like you can call and sign up. This is going to be for people who are part of the client base of Office for Aging. And what we've learned with our collaboration is that the Office for Aging sends caseworkers out who do normal screenings of all sorts. They do screenings for isolation, for depression, for substance abuse, and as part of their normal workday so that they can help point their clients to appropriate resources. They ask them a lot of questions. In doing so, they've noticed that some of them may have some memory issues, but they weren't sure what to do with them.

So this was kind of what spurred our program along. But here in Syracuse, we also noted that we were getting a lot of people who were, had more advanced memory problems or we're in a crisis. Their families suddenly realized that there was a problem, and something was going on, and they didn't know what to do. And so we wanted to figure out how we could reach people earlier on so that we could help them, when we can maximize our care plan and help keep them independent for as long as possible, and help reduce the stress on the caregivers. So there are many factors that kind of came into play when we decided to work on this project.

[00:02:33] Host Amber Smith: So what is the youngest age person that might get services from the Office for Aging?

[00:02:39] Sharon Brangman, MD: The Office for Aging starts providing services at the age of 60.

[00:02:45] Host Amber Smith: OK, 60. And then what counties are included in this?

[00:02:49] Sharon Brangman, MD: So we are focusing on seven counties, and those counties are Cayuga, Herkimer, Lewis County, Madison County, Oneida County, Oswego, and Tompkins County. And everybody asked me, "well, what about Onondaga County?" Well, several years ago before the pandemic, we tested this program out in Onondaga County working with our local Office for the Aging, and we trained one of their neighborhood advisors, and this is someone who would go out to homes that, people in their homes, and tell them about low cost heating options or home repairs and other things. And again, they noticed that some people were a little confused, and they didn't really know how to handle it.

So we trained their neighborhood advisors on doing this mini cog, and we found it worked really well. We got a lot of referrals from people very early on. Now some people didn't want to come, and some people didn't need our services, but then they were aware of them so that maybe down the line they could always take advantage of it. So we found that this was a very workable way to reach people before they were in a crisis.

So from the work we did in Onondaga County, we then expanded it to these seven counties. And then the other thing people asked me is, "why isn't another county added?" You know, they want more. Well, we're testing it in seven counties. And it, you know there are expenses associated with this, but we're hopeful that once we show that these seven counties are successful, we can get this worked into the budget for the New York State Office for Aging, for the whole state. So we have to start somewhere.

[00:04:41] Host Amber Smith: Sure. Now, why is it important to find out early if someone has memory problems?

[00:04:49] Sharon Brangman, MD: Well, memory problems, we have learned, are one of the biggest concerns that people have as they get older. And they automatically think if they have a memory problem, that they have dementia or Alzheimer's disease. And so that often makes people so afraid it paralyzes them and they don't do anything about it, or they make up excuses.

But what we want people to know is that not every memory problem is dementia or Alzheimer's disease. It could be related to a number of things that it would be good to get it evaluated so that we can address them. And then if it turns out to be something like a dementia, it's better to catch it as early as possible because the current treatments are most effective in the early stages. And then we also find that families and caregivers benefit from education and support services, and the patient can actually participate in making decisions for themselves and other things because then down the line, we don't want people to be in a crisis when their options are limited.

[00:05:56] Host Amber Smith: Well, I'd like to ask you a little bit more about the memory screening. I know it's you called it a mini cognitive test, so it's really short, right? Can you kind of walk us through how it's done?

[00:06:06] Sharon Brangman, MD: Yes. It's called a mini cog. And it was developed to be given in less than five minutes. It's not a diagnostic test. And so there's no pass or fail, or if you get a certain score, then that means you have dementia. It's really a screening test, which means we just need to look a little closer at that person.

And we ask them three words. Then we ask them to draw the face of a clock and put a certain time on the clock. And then we ask them those words again, and there are certain points you get. So it is something that is easy enough to teach to someone who doesn't have a medical or a nursing background. And it can be done out on the road in a home setting. It doesn't have to be done in a hospital or a doctor's office. And again, it's not making a diagnosis. It's just giving us some information about someone we may want to look a little closer at.

[00:07:06] Host Amber Smith: So if you do come across someone that you should look a little closer at, what does that involve? Like, what are the next steps after that?

[00:07:14] Sharon Brangman, MD: So part of the training that we did for these workers is to teach them how to administer the test and then to review with them the process for making a referral. And so our team on this side here at Upstate is ready to get these referrals. And we gave the Office for Aging workers the process for making that referral.

And it's not a forced thing. If someone doesn't want to do it, no one is going to nag them or refuse to provide them services. It's just offering them an option to look a little deeper if they are interested.

[00:07:52] Host Amber Smith: So information like this, that something might not be working as it used to, can be unsettling. Are there people at the Center for Excellence for Alzheimer's Disease who can help families digest this?

[00:08:07] Sharon Brangman, MD: So absolutely. This is what we do every day. We've been doing it for years. We are the only center in the region that provides this type of comprehensive care. So we have a whole team. You can get a medical evaluation, you can get deeper testing with neuropsychologists that are embedded in our team. We also have nurses who can help families gather information, and we have a team of social workers that can let patients and families know about resources in this area. The Center of Excellence for Alzheimer's Disease serves 14 counties. That includes these seven counties, plus seven additional counties, so we're aware of the resources and the support services in the whole Central New York region.

[00:08:59] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Alzheimer's and geriatrics expert, Dr. Sharon Brangman.

Now, what is the role of your partner at Syracuse University, Dr. Maria Brown?

[00:09:14] Sharon Brangman, MD: So, Dr. Maria Brown and I have worked together on a number of projects over the years, and she and I worked together on the initial pilot program that we did here in Onondaga County.

And actually, if you look back, she did some of her training with us, back when she was a graduate student. So we've known about her for years, and she's always had an interest in aging and in helping people with dementia and memory problems. And her role is really helpful because she can help us analyze the data to see if what we're doing is effective and to help us understand if we are hitting all the targets that we hope to get -- and then help us determine if this is something that we can then expand to other counties in New York state. So her expertise is evaluation of a program and the data that's being collected and organizing that data for us.

[00:10:11] Host Amber Smith: So previously you looked at residents of Onondaga County. Can you tell us what you found looking at just that county?

[00:10:18] Sharon Brangman, MD: So just looking in Onondaga County, which you think with us being so close to those residents, we found that a lot of them did not know where to go. They didn't have information about memory loss. Their families didn't know what to do.

A lot of primary care physicians in our region are, over overscheduled. They have so many patients and really only about 15 minutes to evaluate somebody, which nobody thinks is enough time, but it's the way our health system is set up.

And so it was very hard for them to get information. And then we have the fear factor. You know, people are afraid as they get older, if they're forgetting something, that it means that they have a dreaded disease. And so they would put things off unnecessarily sometimes. So it was a combination of things that we found when we did it here in Onondaga County that made us realize that this was an important program to try to expand to other older adults.

[00:11:25] Host Amber Smith: Well, 20 years ago, 10 years ago, you didn't have that many options to help someone who was having memory loss or early dementia, but that's changed now, right?

[00:11:37] Sharon Brangman, MD: Well, yes. We've always said that we can't cure this disease, but we can always care. And we can always help people handle the stresses associated with dementia. We now have some medications that, although they don't cure, in the early stages they may help to stabilize for a period of time. So that's something that people can be offered if they're eligible and if they're appropriate.

But most of all, it's understanding what's going on so that people can do what we call anticipatory planning. We try to help people anticipate what might come next so that they can plan ahead.

[00:12:19] Host Amber Smith: Now, are there any reasons someone over 60 in the participating counties might not want to get a memory test? I'm wondering if there's anything that would disqualify someone from participating.

[00:12:32] Sharon Brangman, MD: No, there's no disqualifications on our end at all. Some people may not want to have one. They may not care to go through the testing or something like that, but that's their decision. But there's nothing on our end that would exclude anyone.

Even though we're geriatrics and we generally see people who are 65 and older, when it comes to memory loss, we see people of any age. So we have seen people in their 50s, in their early 60s, every now and then, somebody a little bit younger. But when we look at Alzheimer's disease and other dementias, they're primarily a disease of aging. So these are diseases that are more prevalent as we get older.

[00:13:16] Host Amber Smith: Are there any health conditions, medical conditions that predispose someone to have memory problems?

[00:13:23] Sharon Brangman, MD: So that's why it's so important to get checked. Because if you have high blood pressure and that's not under good control, or if you have diabetes and that's not under good control, or if you have high cholesterol and that's not under good control, if you're overweight and not exercising, there's also lots of medications that someone might be taking even without a prescription, and those can affect your memory.

So there are a lot of things that can happen as we get older that can have a negative impact on our memory, but it doesn't mean that you have dementia. So what we try to do is optimize someone's health and tell them what they can do to reduce their risk, if we find that they don't actually have a real memory problem.

Now, there are certain memory changes that happen as we get older that are completely normal, and that's when people get nervous. So, for example, it takes us maybe a little bit longer to remember someone's name. You meet someone at a party, or if you're out in the grocery store and you see someone coming and you suddenly can't remember their name, you can remember other things about them and where you knew them from, but you just can't remember their name. And then, about a half an hour later or something, maybe you're driving home and you remember their name. That's called slow retrieval. That's actually normal as we get older.

So I like to tell my patients, it's like your brain is a big computer full of information. And as you get older, it has more and more pieces of information. It can take a little bit longer to dig through those files in your brain and pull out that name. So that doesn't necessarily mean you have dementia. That's called slow retrieval. That's OK. Or you might forget where you put your glasses, your cell phone, your keys, and you're looking all over for them. Generally, as we get older, we are thinking of too many things at the same time. So when you put your cell phone down, you don't remember where you put it. But if you sit and think for a minute, you can retrace your steps and find it.

So what we're doing generally, most of us, is that we're on overload. We get so much information. We have breaking news, we have big newspapers to read on the weekend. I probably have too much information about the Kardashians in my brain. So we get all these idle, useless pieces of information, and they take up room. So that is not necessarily dementia. That means we're not focusing on the task at hand. We're thinking of too many things at once. So that's some of the things that we talk about with patients and families and reassure them what's normal and what may not be normal.

[00:16:30] Host Amber Smith: So if a person has slow retrieval or can't figure out where they've left their keys from time to time, would they probably still be able to pass the mini cog test?

[00:16:44] Sharon Brangman, MD: It depends. So that's why, just because you may get a referral, it doesn't mean that you have dementia. It just means we need to look a little closer and then we can help that person figure out ways to reduce their overload or to optimize their health so that they can have their brains working at the best way possible.

[00:17:08] Host Amber Smith: Well, that sounds like a really good idea and very good information. I want to thank you for making time to tell us about it, Dr. Brangman.

[00:17:15] Sharon Brangman, MD: So yeah, this is the, these are the things we all worry about. These are the everyday concerns, and it's not necessarily dementia.

[00:17:26] Host Amber Smith: My guest has been Dr. Sharon Brangman, the director of Upstate's Center of Excellence for Alzheimer's Disease. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.