Swank Center for Memory Care and Geriatric Consultation at ChristianaCare

The Swank Center sees patients over 60 with suspected memory/cognitive complaints who are residing in the community (living at home).

Questions of legal capacity related to health care decision-making, finances, exploitation or abuse, and living arrangements commonly arise in patients with memory disorders. As these matters may require the involvement of the legal system and a judicial determination of competency. Swank providers do not perform capacity assessments, nor do we complete competency evaluation paperwork. The Swank Center provides outstanding clinical care to our patients. Our program is not designed to provide the forensic consultative services that are required under such circumstances.

There are two main categories of treatment for Alzheimer’s disease: Symptomatic Treatments and Disease Modifying Treatments.

Symptomatic treatments such as cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine provide temporary improvement in cognitive symptoms such as memory loss but do not alter the overall course of the illness.

Disease modifying treatments are treatments that can alter the course of the illness and have the potential to slow the rate of memory/cognitive decline. Currently, there is only one approved medication available in this category, Leqembi (lucanumab). This medication is given as multiple infusions over several months. However, Leqembi is not appropriate for all patients. All patients seeking treatment with Leqembi must undergo extensive pre-treatment assessment and review, including genetic testing, neuropsychological testing, biomarker studies (PET scan or spinal tap), and brain MRI to determine safety and eligibility.

Mild cognitive impairment (MCI) is a condition in which one has memory and/or other cognitive complaints that are noticeable to the patient or others and create difficulty, but do not cause severe impairment in functioning. In other words, patients with MCI while needing reminders and other assistance, can still generally function independently. Patients with dementia, on the other hand, have cognitive complaints that do result in severe impairment in functioning. These patients struggle with activities of daily living (ADL’s) and their level of impairment is such that they have difficulty functioning independently.

Dementia, or what is also called major neurocognitive disorder, is a condition in which there are changes to the brain that cause significant impairment in functioning. Cognitive symptoms of dementia can include memory loss, difficulty with language, emotional disturbances, impaired judgment, psychiatric symptoms (depression, anxiety, psychosis), and changes in personality or behavior. Many conditions can cause dementia.

Alzheimer’s disease is the most common cause of dementia, but other conditions also cause dementia such as Parkinson’s disease, Lewy Body disease, Frontotemporal dementia, vascular dementia, certain infections, and vitamin deficiencies amongst others. A thorough memory disorders assessment includes studies to rule out these conditions.