The staff of the New York Memory and Healthy Aging Services offer comprehensive care for patients and families with neurologic conditions.
We care for patients at the office and make home visits if needed.
This generally consists of an extensive history, general medical, neurological and specialty examination lasting an hour. Following this initial evaluation, a patient may then require no further testing, or may require one or more of the following evaluations:
- Neurocognitive Testing
These tests are designed to elicit disturbances in memory and thinking. Just as a cardiac stress test is helpful in diagnosis, treatment and prevention of heart diseases and heart attacks, appropriately administered and properly interpreted neurocognitive tests are invaluable in brain dysfunction. Depending on the symptoms, individual tests are selected to best evaluate each associated brain area. Testing lasts about four to five hours.
- Neuroimaging (MRI, SPECT, PET)
Brain imaging includes both structural (CT scan or MRI scan) and functional imaging (SPECT or PET scan). CT or MRI scans are performed to rule out 'mini-strokes' or other structural causes for memory loss. At times, these strokes are 'silent', manifesting mainly with memory loss, rather than paralysis or other such difficulties.
SPECT or PET scans evaluate brain functioning rather than structure. These scans measure blood flow to brain regions or the use of nutrients by areas of the brain. Such scans help pinpoint areas of difficulty when an MRI or CT scan is normal. Other functional imaging techniques include functional MRI. Generally, functional imaging of the brain is not performed routinely, but only in a subset of patients with memory difficulties, where there may be diagnostic difficulties. For the genetic counseling and caregiver support programs, the consultation will be geared to address these issues and will not usually involve testing. Instead information about the affected family member will be needed to answer an individual's concerns.
The EEG is a measure of the activity of the nerve cells of the brain. Just like an ECG or an electrocardiogram evaluates the electrical activity of the heart, an EEG or an electroencephalogram evaluates the electrical activity of the brain. During this painless procedure, small, flat metal discs are attached to your scalp to detect electrical activity in your brain. Your brain cells communicate via electrical impulses and are active all the time, even when you're asleep. This activity shows up as an EEG recording. Abnormal EEG patterns help physicians in diagnosing conditions like seizure disorder or other brain disease.
- Lumbar Puncture
In this procedure, under sterile technique, after consent is obtained, a needle is inserted into the lower back and cerebrospinal fluid is withdrawn for analysis. Dr. Devi has performed several hundred such procedures over the last 25 years.
Repetitive transcranial magnetic stimulation (rTMS) is a safe and noninvasive technique of altering activity in focal areas of the brain using magnetic pulses. This is an emerging technology that is currently FDA approved for the treatment of depression and for neurodiagnostic assessments.
- Cognitive Remediation
The primary aim of cognitive remediation is to reduce cognitive deficits. Cognitive deficits can manifest as attention, memory, and executive function (ability to organize one's actions and speech) disorders. These types of difficulties may compromise the social and professional integration of people suffering from them. Cognitive remediation is a type of rehabilitation treatment offering exercises with an aim at improving attention, memory, language and/or executive functions. The expected result is an indirect positive impact on functional deficits affecting everyday life. Proper treatment with these therapies can help enhance the social and professional integration of patients.
- Physician Home Visit
Home visits are reserved for home bound patients for initial consultation, follow ups, and overall patient care.
- RN Home Visit
Nurse home visits can include drawing blood, administering medications, vital signs, medication management ad overall wellness and safety. Dr. Devi oversees these visits and ensures that appropriated strategies are adopted when necessary to maintain health.
- Epley Maneuver
The Epley Maneuver is a treatment for vertigo caused by a disorder called BPPV (benign paroxysmal positional vertigo). In this condition, microscopic otoliths, dislodged within the inner ear wreck havoc on balance, producing vertigo. With a simple office procedure, the otoliths are repositioned, curing vertigo. A review in the New England Journal of Medicine notes that when properly done, success rates for curing vertigo with a single repositioning session is 90-95%.
- Genetic Counseling
Adult children of patients with Alzheimer's disease and dementia may wish to determine their risk for the condition and to objectively determine their cognitive baseline. An assessment of risk factors and methods to reduce risk for developing dementia is formulated for each person at risk.