Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Nantz National Alzheimer Center

NNAC Clinic Experience

We understand that making an appointment with a neurologist for yourself or your loved can be intimidating. It may seem like taking a step into the unknown. We’d like to walk you through what you can expect during your initial appointments with us at the NNAC.

It is important to make an appointment to see a neurologist as early as possible, so that you can get help for your loved one and yourself. We hope this description will alleviate some stress and make the process more comfortable.

Before Your Visit

When you call the NNAC to schedule an appointment, you will speak with Nena Bernal. She will help you get started and book the appointment. Nena will then send you a few questionnaires to fill out in advance, so that the time during your visit can be used to the most benefit for you and your loved one.  You will be given several documents to fill out and return:

  • Medical history questionnaire - This can be filled out by the patient or the caregiver, depending on the patient’s abilities. Most of the time, the caregiver fills it out. This form includes information about the patient regarding his/her medical background, history with primary care physicians, and information on any specialists that the patient has already seen.
  • Release of medical records - You will be asked to sign a release of medical records so that our office can request any relevant scans, procedures or medical reports that might contribute to our overall understanding of the patient’s condition as it relates to potential causes of dementia or Alzheimer’s disease.
  • For the caregiver - The caregiver is asked questions about the patient’s memory, judgment, problem-solving abilities, social interaction, hobbies and personal care.
  • For the patient - The patient is asked to answer questions about his/her own mood and state of mind.

Your First Appointment

Both the patient and the caregiver are invited to all appointments. The first appointment at NNAC typically lasts one to two hours. You will meet with one of our world-renowned specialists, Dr. Gustavo Román or Dr. Bryan Spann. You can ask as many questions as you’d like.

The doctor will walk the patient through some basic tests that will help him evaluate the patient’s current cognitive status. Each of these exams helps us form a more complete picture of the patient’s overall condition and helps us define next steps:

  • Memory: Evaluates both long-term and short-term memory.
  • Executive function: Evaluates the ability to plan or manage basic daily behaviors and understand how things work visually and functionally.
  • Neurological function: Evaluates reflexes, balance and gait.

We will also take blood and urine samples. These samples help with a whole myriad of analyses. Using these samples, we will see if the patient is experiencing inflammation, electrolyte imbalances, vitamin imbalances, heart or vascular disease, anemia, bacterial infections, thyroid imbalances, calcium deficiency or other conditions that might cause symptoms or contribute to the patient’s disease.

If the patient has no recent MRIs, CT scans or PET scans, we will schedule these, as necessary.

If there is no recent neuropsychological exam to reference, or if the patient has never had a full neuropsychological exam, this will also be scheduled. Dr. Kenneth Podell and Dr. Mario Dulay are neuropsychologists at the NNAC who see patients with different forms of dementia, including Alzheimer’s disease.

We will help set up a meeting with our compassionate, experienced and capable social workers, who can help provide valuable tools and assistance with every step of this journey.

At the end of the first visit, it is not likely that we will have a diagnosis, but we will be substantially closer. The doctor will talk with you and make sure all your questions are answered to the best of our ability, and we will have next steps defined for you. You will know what to do to move forward.

After Your First Appointment

During the weeks after your first visit, you may have a battery of tests scheduled, possibly including an MRI, CT, PET, neuropsychological exam or a sleep study, as needed. The neuropsychological exam can take four to six hours. It will thoroughly assess the patient’s entire executive function, memory, cognition, thought process and decision-making skills. The information gathered in all of these tests will be very valuable for the second visit.

You may also want to meet with one of our social workers, who can help in many ways. Our social workers can help you in dealing with the specific stresses of having a loved one with memory or behavioral challenges. They can refer you to resources that will make the job of caregiving easier.

Your Second Appointment

You will meet with the same physician from your first visit – either Dr. Román or Dr. Spann. He will be familiar with you and he will have evaluated all of the information from the additional exams.

He will ask you follow-up questions, and he will answer any new questions that you have. It is likely that we will have a more specific diagnosis at this visit. As you may know, Alzheimer’s disease cannot officially be diagnosed prior to autopsy, however we will let you know if we believe it is AD and should be treated as AD.

You will leave with a treatment plan, prescriptions for any necessary medications, follow up appointments booked, and assurance that you are in good hands and there are people to help you and your loved one.