After a scary diagnosis, a patient sought a second opinion at Yale Medicine’s Adler Memory Clinic. She got a clear explanation and tools to get her life back on track.
- Memory loss can be a sign of vascular dementia—the second most common form of dementia after Alzheimer’s disease.
- When normal blood flow to the brain is reduced or blocked, it can damage brain tissue.
- This may affect a person’s ability to plan, concentrate, or remember things in the short term.
- A neurologist who specializes in memory disorders can perform brain imaging scans (such as CT scans or MRIs) to reveal where damage may have occurred.
- Cognitive assessments will determine how the patient has been affected.
- Lifestyle modifications can help preserve and improve mental abilities.
Shelly had taken a course in weaving—twice—and had worked hard to learn the craft. As determined as she was, though, she could not make much progress on her weaving.
“I think there’s something wrong with my brain,” the 66-year-old retired schoolteacher told her husband. “I understood what I was supposed to do, but something went wrong every time.”
Her time management skills, which for all her life had been excellent, had also started to slip.
The changes were jarring for a woman used to juggling a busy lifestyle. Shelley was a mother, a marathon runner and a career educator who spent 37 years teaching kids from preschool through college. But since retiring a few years earlier, she had become less organized and less efficient. She had also started to have trouble with fine motor tasks, such as snapping and buttoning her clothes.
But in 2014, when she found the weaving project unraveling, again and again, “it was really telling,” Shelley says. She realized she needed to figure out what was going on.
Causes of memory loss
Shelley made an appointment with a psychiatrist, who then referred her to a neurologist for an assessment, an electroencephalogram (EEG) and a magnetic resonance imaging (MRI) brain scan. To her surprise, the tests revealed that she’d had multiple strokes. Because she had a history of heart disease (a stent was implanted in 2008 to relieve a clogged artery), Shelley knew that she had a high risk of stroke, but she had no idea that she had had one, let alone more than one.
The good news was that the strokes were minor. The bad news was that they had caused damage to tissues deep in her brain.
Shelley was diagnosed with vascular dementia, a progressive impairment in cognitive function due to reduced blood flow to the brain. And after he saw the results of her electroencephalogram, which detects electrical activity in the brain, the doctor thought Shelley may also have had a seizure disorder and put her on an anticonvulsant medication.
For Shelley, who already took medication to manage her anxiety and depression, all this scary news felt like too much to bear. Then a family member suggested that she seek out another opinion, at Yale Medicine’s Adler Memory Clinic. Although Shelley and her husband lived far away, in Keene, N.H., they decided to seek treatment for her in New Haven.
A memory clinic for cognition and speech problems
Staffed by four experts in cognitive neurology, Yale Medicine’s Adler Memory Clinic diagnoses and treats patients who have cognition and speech problems, often caused by dementia or traumatic brain injury. Co-directed by Dr. Stephen Strittmatter and Dr. Arash Salardini, the clinic helps about 1,000 people each year. About half have Alzheimer’s disease.
“The 50 percent who don’t have Alzheimer’s have a range of other conditions, all of which have different prognoses, behavioral problems, and treatments,” says Dr. Strittmatter. “Sometimes dementias are misdiagnosed. We work together and try to ferret out what to do.”
Yale School of Medicine is one of the world’s top neuroscience research institutions. Dr. Strittmatter, who directs his own neurology laboratory at Yale, has led the way with groundbreaking Alzheimer’s disease research for years.
“Compared to 10 years ago, we now have a lot more certainty about what’s going on in the brain,” says Dr. Strittmatter. “We have imaging scans and have done clinical studies tracking patients as they developed memory difficulty. We have a lot more confidence about making predictions.”
To find out more about memory loss in seniors, click here.
The anxiety effect
The clinic’s approach to treatment is comprehensive. It relies on some of the nation’s most sophisticated imaging techniques, as well as a battery of neuropsychological tests. The goal is to assess memory, organization, language and other cognitive functions.
Shelley’ was deeply relieved to learn, after a full workup, that she did not have vascular dementia or any significant cognitive decline. Her new problems with concentration were stress-related, Dr. Salardini told her. Attention and stress are mediated by similar receptors and mechanisms in the brain. The physiology of these receptors differs from one person to the next, says Dr. Salardini. Stress is a natural, protective mechanism in the brain that keeps us distractible, in case of emergency. But high stress levels can hinder memory retrieval and cognitive task organization.
“In Shelley’s case, she had become a very successful educator by employing her particular style of cognition and goal-setting to wonderful effect,” he says. “However, with age, brain vascular lesions, loss of daily routine post-retirement and specifically increased stress, she felt less efficient compared to her former self.”
Dr. Salardini helped Shelley right her course. In the most important conversation she’s had with him, he told her that she would need to focus on three primary areas: treating her anxiety, maintaining her cardiovascular health and making lifestyle adjustments.
“He said, ‘Number one, you need to get your medication right,’” Shelley said. “ ‘Your antidepressant is not doing for you what it should be doing.’ "
Dr. Salardini urged Shelley to be assertive with her psychiatrist about finding the best medications; gradually, she reports, they’ve found better options. She also sees a counselor regularly who helps her find ways to manage her anxiety in relation to specific tasks—such as getting ready for a trip or packing up her home.
Since having one stroke increases a person’s risk of having another, Shelley also need to adjust her lifestyle in order to protect her heart. It was important for her to monitor her blood pressure, stay active, eat well and take her medications—statins to keep her cholesterol in check and blood thinners to prevent blood clots and further strokes.
The same active approach could help ease the deficiencies in her working memory, Dr. Salardini said. Since retiring, Shelley's life had become less structured, which also may have contributed to her anxiety. Adding more order to her days would help her organize her thoughts and schedule, the doctor told her.
For five months, she spent three full days a week caring for her young grandson. It was exhausting, but it helped bring structure to her life. "It absolutely worked,” she says.
“The facts are hard for me,” says Shelley, remembering how she had cried when she first learned that she had had a stroke. But she has learned to compensate. “Now, I’m much more aware of things,” she says. “I give myself more time to get ready so I can be on time. I don’t like being late."
A path forward
Working with Dr. Salardini, Shelley has been able to make sense of her condition. “Dr. Salardini was able to integrate everything for me so I could really understand it all,” she said. “He was patient and very, very smart. He’s been absolutely fantastic.”
She continues to see Dr. Salardini as a patient, and soon she will have a shorter commute: She and her husband are planning to move from Keene to Orange—closer to her daughter and grandson, and to Yale Medicine.
Shelley says she is well on her way to being able to fully savor her retirement and role as a devoted grandmother.
“I’m considerably better off now than before I came to Yale,” says Shelley. “I’m very optimistic.”