Category: News

5 Steps to Take After a Memory Disorder Diagnosis

A memory disorder diagnosis can seem overwhelming and intimidating. Whether you are living with a diagnosis, or caring for someone with a memory disorder, there are many variables to consider when planning for the future. 

Sarah Harlock, Program Director for the DENT Integrative Center for Memory, shared five important initials steps to take after receiving a memory disorder diagnosis. 

  1. Gather important documentation.

    • Power of Attorney

    • Health Care Proxy or MOLST (Medical Orders for Life Sustaining Treatment)

    • Veterans Discharge papers etc.,

  2. Get some information about the diagnosis. You do not need to learn everything about the illness but have a sense of the types of challenges you may be faced with.

  3. Learn more about supportive services that are available such as community based programs, health services, and levels of care. Gather information to determine costs and how one enrolls in these services. 

  4. Make a plan (nothing is written in stone,) just create an outline of services you think you might like to try when necessary.

  5. Breathe! You have to learn to live with this diagnosis, and there is a lot of living still to do

While there are many other steps to take and adjustments you may need to consider, completing these initial steps will help you and your care partner begin planning for challenges that may arise in the future. 

For more details about programs and services, questions about making a plan, or more information about cognitive changes, please contact Sarah Harlock, Program Director for the DENT Integrative Center for Memory, at 716-250-2000, ext. 1107. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

Dementia and Communication – Facebook Live Recap

Dementia is an umbrella term used to describe a group of symptoms. Those symptoms can arise as any negative change related to thinking, including; difficulty with memory, language, reasoning or problem solving. Those symptoms, commonly referred to as cognitive changes, may affect the way a person communicates. 

Program Director for the DENT Integrative Center for Memory, Sarah Harlock, explained over Facebook Live why these communication breakdowns happen and techniques you can use to improve communication between you and the person in your care. 

Importance of Communication:

It is important to note that there are many types of dementia, including but not limited to; Alzheimer’s disease, Lewy Body dementia, and Frontotemporal dementia. That being said, it is important to understand that communicating with someone with Alzheimer’s disease may be different than communicating with someone with frontotemporal or vascular dementia. Approaches in communication may need to vary from person to person, dementia diagnosis to dementia diagnosis.  

“It’s helpful to think of dementia communication as a continuum. The person you’re caring for with Alzheimer’s may not be able to communicate the same way as the person sitting next to them who also has Alzheimer’s,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.

“Communication, at its core, is about connecting with another person,” said Harlock. “Although, sometimes communication may be about giving an instruction or direction, try to remember that communication is about making emotional connections and that is what the person with dementia is trying to do.”

In the later stages, dementia can be accompanied by changes that may impact a person’s ability to communicate. 


Vision Changes:

Vision changes are a large part of a late stage dementia diagnosis. A person with late stage dementia may experience significantly diminished peripheral vision.

“For example, if you put a cup of coffee on the side of their place-mat and they keep asking ‘where’s my coffee,’ you, as a care partner may be frustrated and keep saying ‘it’s right there, it’s right there’. It’s important to remember that they are not asking to annoy you, or be difficult, the loss of peripheral vision has made it so they really can’t see it,” added Harlock.  

Depth perception and the ability to discriminate colors can also diminish as a dementia diagnosis progresses.


Hearing/Auditory Changes:

As dementia progresses, hearing changes can occur making it difficult for a person with dementia to hear certain pitches, particularly higher pitches.

In addition, as the disease progresses it can be hard for a person to distinguish between background noise and foreground noise.

“Whereas our brains can tune out background nose and focus on the conversation at hand, that can become increasingly difficult for a person with dementia, making it hard for them to follow a conversation,” added Harlock.

Creating a quiet and calm environment can be helpful when trying to communicate with a person in that stage.


Sensory Perception:

The importance of sensory perception can often be overlooked. However, sensory perception can be very important for people with dementia. Often they can become too hot or cold, and even the feeling of clothing can be uncomfortable for the person, so try to be mindful of that.


Processing Time:

When having a conversation with someone we expect them to respond back in a timely manner or give us non-verbal clues that they are thinking about their answer. This processing time can change significantly for a person with dementia.

“Processing time for someone with moderate to late stage dementia can take up to 90 seconds,” said Harlock. “In that case, repeating what you said louder again and again won’t help, it will only frustrate the person. Slow it down and give them a chance to process the information,” said Harlock.  



“Many times, in the late stages,  a person with dementia may revert back to their primary language. For instance, if a person’s first language was Spanish, and they learned English later in life, it is not uncommon for a person to begin solely speaking Spanish,” added Harlock.



Emotion can play a large part in communication for someone with a memory or mood disorder.  For example, if a person is anxious it causes them to be distracted, which can affect their ability to retain information.

“It is important to recognize that a person’s emotional state will impact their ability to communicate,” said Harlock. 


Verbal vs. Non-Verbal Communication:


There are many things you can do as a care partner to make communication easier for you and the person you’re caring for, both verbally and non-verbally.


Verbal Communication:


Word Choice:

When speaking, avoid slang or jargon. Remember to slow it down, including both talking slower and allowing for a longer processing period.


Tone of Voice:

“If you want someone to do something, make sure you are saying it in a way that makes them want to cooperate with you. If you are gruff, unfriendly, or you’re stressed out, the person will pick up on that and be less likely to do what you are asking of them,” said Harlock. 


Non-Verbal Communication:


“Most communication that happens is non-verbal. Body language, facial expressions and eye contact, all play a big role in communication,” said Harlock.


Facial Expression:

Facial expression can play a huge role in communication with a person who has dementia. “If you looking for someone to do something, make sure you are making the correct facial expression that will get you the cooperation you need, “ said Harlock.


Body Language:

“If you are acting aggressive or assertive a person with dementia will pick up on that and think ‘Whatever he/she wants me to do doesn’t look like fun, so I’m not going to do that.’ So make sure your body language is really calming.” added Harlock.



“If understanding language has become very difficult, we can use gestures to get our point across,” said Harlock


Eye Contact:

“Due to the vision loss, make sure you are in their line of sight and engage them in conversation,” said Harlock.


Effective Techniques will vary from person to person and type of dementia to type of dementia, however generally these tips can be very useful for creating meaning and effective communication.


1.     Speak slowly and calmly

2.     One question or instruction at a time, keep it clear and simple.

3.     Allow time for a response. *remember it can take up to 90 seconds to process the information and respond

4.     Tell the person what you want them to do, not what you don’t want them to do.

5.     Be more positive in your communication. Avoid using the word no (unless safety is at risk, then use the words you need to

6.     Simplify questions, don’t make them too long, keep them clear and concise




There are a few additional techniques that can help have more positive and productive communication with the person in your care.



Validation is a way of opening up communication lines.

If the person you are caring for keeps saying ‘I want to go home now’ rather than saying something terse, like ‘you are home’ over and over,  try a different approach like, ‘tell me about your home or what home are you thinking about.’

This method will open the door and allowing for meaningful and productive communication.


Therapeutic Fibbing:

Described as a detour from the truth, this technique can be very helpful and very kind for the person with dementia. This technique is best used when telling the truth will be more hurtful than helpful.

“I once worked with a woman who had dementia and would get very upset that her mother didn’t know where she was. She would become agitated wanting to get in touch with her mother. Unfortunately, the woman’s mother had died many years ago, however, instead of saying ‘your mother passed away’ only creating further agitation. we would use therapeutic fibbing to say something like “Your mother called, she wants you to stay for dinner,” and immediately the woman would calm down and be so relieved that her mother was no longer worried,” said Harlock.


Watch the full presentation below:


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

What is TMS Therapy?

Transcranial Magnetic Stimulation or TMS therapy, is an FDA approved treatment for depression that utilizes energy to stimulate the brain and facilitate improvements in depressive symptoms. The treatment utilizes short pulses of a focused magnetic field to stimulate nerve cells in the area of the brain thought to control mood. This brief and painless treatment is performed in a quiet, comfortable setting under the supervision of a psychiatrist and is administered while the patient is awake and alert.  

We sat down with Physician Assistant in the DENT Psychiatry Center, Michael Asbach, who explained how TMS works to treat depression. 

1. How does it work? 

“A 3 Tesla magnet, which is the same strength magnet used in an MRI, is placed over the area of the brain known as the dorsolateral prefrontal cortex. The powerful magnet sends pulses through the skull and causes depolarization of the neurons in the superficial cortex of the brain. Through neural pathways, the local stimulation causes functional changes in other brain regions and leads to improved cell communication and improvements in depressive symptoms,” said Asbach. “The electromagnetic coil is placed against the scalp and delivers pulses of magnetic field in 30 second intervals involving 40 pulses in a 4 second period with 26 seconds of rest. The magnetic pulses are not painful and feel/sound like a light tapping on the scalp.”

“I often describe the sensation to my patients as if someone were to lightly flick your head 4000 times in a 20 minute period. It may not be comfortable but it is not painful for most.”

2. How long does the treatment take? When can patients expect to see results? 

“The first TMS treatment is called a mapping. At this appointment a medical practitioner and TMS technician will use a computer algorithm to identify the best location on the scalp for treatment. As a result of the mapping, your first treatment session usually lasts about an hour. Subsequent treatments are quicker and last anywhere from 20-30 minutes,” said Asbach.

“Patients receive treatments 5 days a week for 6 weeks or a total of 30 sessions. Patients commonly will start to see improvements in their symptoms about half way through the sessions, however sometimes improvements are not observed until later in the treatment process. The reason being that TMS is causing changes in neuron functioning and communication through the repetitive and sustained exposure to magnetic impulses which stimulate the cells and “wake them up.” This does not occur in just one session and requires continued exposure to the magnetic pulses,” Asbach continued.  

3. What patient population does this therapy work best for?

The FDA has approved TMS for patients with treatment resistant depression. Treatment resistant depression is defined by the failure of two or more antidepressant therapies with adequate trial of dose and duration.

“TMS treatment of depression is covered by most insurance companies although some insurers require further medication failures and/or an adequate trial of counseling. TMS is not recommended for the treatment of depression within the context of Bipolar illness. Additionally, patients with a history of seizures are recommended to consult with their neurologist as TMS treatment has been reported in rare instances to increase the risk of seizure (in normal clinical use the estimated risk of seizure is 0.03% of treatments),” added Asbach. 

4. What are some common misconceptions surrounding TMS that may hold people back from trying it?

A common misconceptions surrounding TMS is that it is an invasive procedure. Patients think that anesthesia is required or drastic alterations to their medication regimen. However, TMS is a non-invasive treatment that is done in the office. Patients are able to drive to and from their TMS treatments and often come to the office to receive their TMS treatment on their lunch break or on their way to work. 

“If patients suffer from depression and have tried 2 or more medications without success, they may be good candidates to receive this innovative treatment,” said Asbach.


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

How to Avoid a Holiday Headache

The holidays are an exciting time filled with social gatherings, gift-giving, and delicious food! However, that also means the holiday season is filled with common migraine triggers. To ensure you don’t get a holiday headache, we sat down with Attending Neurologist and DENT Headache Specialist, Dr. Shivang Joshi, who shared his tips for navigating the holiday season headache free. 

1. What is a migraine trigger?

“A trigger is anything that can bring on a migraine for a patient and it can vary from person to person,” said Dr. Joshi. “Triggers are difficult to study; sometimes a known trigger won’t bring on a migraine. However, a combination of triggers might.”

Common migraine triggers include:

  • stress
  • hormonal
  • skipping meals
  • weather changes
  • poor sleep
  • perfume
  • odors
  • neck pain
  • food.

Additionally, foods containing nitrates or MSG, and red wine, may be also be a trigger for some.

2. How can people identify their triggers?

“Paying attention to common triggers and seeing how they affect your individual migraine can help,” said Dr. Joshi.

Keeping an up-to-date headache diary can also be helpful, especially to identify hormonal related headaches. 

3. What migraine triggers would you expect to increase during the holiday season ?

“The holiday season can be a busy time and it can be stressful if you have to travel or host an event,”said Dr. Joshi.

During the holidays expect stress, poor sleep, alcohol, and food (especially food containing preservatives or tyramine) to be common triggers.

4. What advice would you give to people to cope with that increase?

“Being prepared will help you cope better with trigger induced migraines. Most migraine medications are more effective when you take them at the onset, so make sure to keep them close by.”

Dr. Joshi shared 5 ways you can prepare for the increase in triggers:

  • Keep to your regular routine as much as possible
  • Stay Hydrated
  • Avoid sensory overload
  • Utilize Stress management techniques 
  • Only consume alcohol in moderation

5. If a trigger is unavoidable what can you do?

There are several triggers that are unavoidable and out of your control, such as weather or hormonal changes.

“It is important to not have anxiety over what you cannot control. Preparedness is key,” said Dr. Joshi. “If your medications are not helping, contact your migraine specialist and inquire about other options to break a headache cycle.” 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

What is Epilepsy?

Epilepsy is the fourth most common neurological disorder. According to the Epilepsy Foundation, epilepsy affects 3.4 million people in the United States and 1 in 26 people in the U.S. will develop the condition at some point in their lifetime. 

We sat down with Director of the DENT Epilepsy Center, Dr. Marc Frost, who cleared up common misconceptions surrounding the disorder. 

1. What is epilepsy?

“Epilepsy means that a person has recurrent seizures,” said Dr. Frost. “The type of epilepsy depends on the type of seizures the person has.”

The terms grand mal and petit mal are often misused to describe types of epilepsy. Those terms are simply a description of the seizure. A grand mal seizure occurs when a  person convulses or shakes. A petit mal describes a seizure where the person does not convulse.

2. What is a seizure?

“A seizure is the physical response to an abnormal electrical discharge in the brain,” said Dr. Frost

3. Are there different types of seizures?

“The type of seizure depends on where in the brain the abnormal discharge occurs,” said Dr. Frost. “If it happens where movement comes, the person will have abnormal movements in that part of their body, or a motor seizure. If it happens where sensation comes from, the person will have an usual sensation in that part of the body, also known as a sensory seizure. If the discharge stays in that spot, a person may just have a partial seizure. If that discharge spreads, a person may get confused and act strangely, known as a complex partial seizure. If it spreads to the rest of the brain, the person may have a full body convulsion, or secondary generalization.”

4. Who can be affected by epilepsy?

“Anyone at any age can have seizures and the causes of the seizures may be different at different ages. About 10% of adults will have single seizure. About 10% of those people (1% of the population) will go on to have recurrent seizures, or epilepsy,” said Dr. Frost. 

5. Is epilepsy genetic?

“There are some types of epilepsy that run in families and have a genetic component to them. However, the majority of epilepsy does not run in families,” said Dr. Frost.

6. What should you do if you see someone having a seizure?

“Let the seizure happen,” said Dr. Frost.  “Do not restrain the person or try to hold them down, they are more likely to be injured that way. Try to get the person on the ground and in a safe location. Lose any tight clothing and move any heavy objects away from them. Make sure to turn them on their side, they may vomit and you don’t want them to inhale or they will choke.”

Dr. Frost also stressed to remember to NEVER put anything in someone’s mouth during a seizure. “It is not possible to swallow your tongue, it’s attached to the bottom of your mouth. The person may bite their tongue, but that will heal. Objects put into someone’s mouth can break teeth, be swallowed or choked on, and fingers that are put on someone’s mouth can be bitten off.”

“People may hold their breath or stop breathing during seizure even to the point they start to turn blue. This does not mean that you must do CPR on them. They will start breathing once the seizure is over, so just watch them closely to make sure they do. When the person starts waking up, they will be confused and may get angry or agitated, talk softly to calm them down and guide them to a safe place. Do not try to restrain them, or they may just get more confused.”

“Always, always call 911,” added Dr. Frost. 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

DENT to Host Free Brain Health Screening Event

On Saturday, November 10, DENT will be hosting a brain health screening event. Free and open to the public, this event will give attendees the chance to participate in a 10 minute test assessing each person’s cognitive function. 

This test will be provide attendees and their treating providers with crucial brain health information in order to establish a cognitive baseline. This information is vital in the early detection of Alzheimer’s and dementia. 

Reservations are mandatory. Please reserve your spot by calling 716-250-2000. 

Dr. McVige named 2018 Muscular Dystrophy Association’s Honoree

 Dr. Jennifer McVige, director of the DENT Concussion Center, was honored as the Muscular Dystrophy Association’s 2018 Honoree. Dr. McVige received this prestigious award for her dedication to patients suffering from Neuromuscular disorders, especially her work with Spinraza, the breakthrough therapy for children suffering from Spinal Muscular Atrophy (SMA). According to the Muscular Dystrophy Association, SMA is a genetic disease affecting the part of the nervous system that controls voluntary muscle movement, taking away a person’s ability to walk, eat, and breathe. However, SMA does not affect a person’s ability to think and interact with others. SMA is the number one genetic cause of death in infants.

Dr. McVige was the first physician in New York to administer Spinraza to a pediatric patient. 

“What is particularly special about her and what we cherish so much about her is her passion for her patients and her dedication to the community,” said CEO of DENT Neurologic Institute, Joseph Fritz.

Congratulations, Dr. McVige!

McVige MDA 2
Dr. McVige and Executive Director of the Muscular Dystrophy Association, Tony Ortega.

Dr. McVige winning MDA Award  

Dizziness, Balance & Tinnitus – Facebook Live Recap

By the age of 65 dizziness is the third most common complaint bringing people to the doctor, rising to number one after the age of 75.  However, dizziness and balance problems can affect people of any age. According to the National Institute of Deafness and Other Communication disorders, more than 1 in 20 children suffer from a balance disorder with that number increasing with age.

Danielle Grisanti, ANP-BC and Jordan Trigilio, FNP-BC, are both providers in the DENT Dizziness, Balance and Tinnitus Clinic. Specializing in general neurology and disorders affecting the inner ear, Grisanti and Trigilio sat down with us to discuss common disorders within their specialty.

“Through our research we have found that on average patients will have seen three different providers before making it to our Dizziness, Balance and Tinnitus clinic,” said Grisanti. 

Those providers often prescribe patients suffering from dizziness, Meclizine. Meclizine is a medicine that may temporarily reduce symptoms of dizziness or imbalance, but will not have long term improvements.

“At the DENT Dizziness, Balance and Tinnitus Center our goal is to not only find the underlying cause of your dizziness, but to appropriately treat both the dizziness and the underlying condition,” said Grisanti.

Dizziness vs. Vertigo

What is the difference between dizziness and vertigo?

Dizziness is often described as a sensation of floating. Patients who suffer from dizziness may feel light headed foggy, or disorientated.

Vertigo is the feeling that the entire room is spinning and can last differing amounts of time.

Types of Dizziness

Peripheral vs. Central Dizziness

There are two types of dizziness that patients may be experiencing, peripheral and central dizziness. Peripheral dizziness is a dizziness that originates in the vestibular system, or middle ear.

Common Peripheral Dizziness disorders include:

•   Benign Paroxysmal Positional Vertigo (BPPV)

•   Vestibular Neuritis

•   Meniere’s Disease

Central Dizziness originates in the central nervous system. This type of dizziness can be a caused by a problem in the brain stem. 

Common central dizziness disorders include:

•   Benign Recurrent Vertigo

•   Migraine Associated Vertigo

•   Chronic Subjective Dizziness

•   Mal de Debarquement Syndrome

Diagnostic Testing:

At DENT we have a number of diagnostic tests available to determine the cause of your dizziness and imbalance.  One of the tests our providers use is a Videonystagmography, or a VNG test. The VNG evaluates the balance function of the inner ear by observing eye movements. 

Rotary Chair testing is another way of evaluating how well your eyes and inner ear are working together. This test helps determine whether your dizziness or imbalance is caused by non-vestibular disorders.


Imbalance is described as an unsteadiness without light-headedness or dizziness. Imbalance is fairly common in older populations as 40 percent of the neurons associated with balance are lost by the time a person turns 75.

 For issues with imbalance Grisanti and Trigilio recommend giving the brain a fourth point of stability.  

“We need 3 systems to work well in order to maintain balance,” says Grisanti. “The eyes, ears, and feet are all engaged to assist the brain in maintaining stability. If there is a dysfunction in one of those systems, you’re going to have a balance issue.”

“This where patients will do well with an assistive device like a cane,” added Trigilio. “Giving the brain that third point of stability if you do struggle with balance is often helpful.”


Tinnitus, or a ringing in the ears, is an audiologic phenomenon that occurs due to hearing changes and the way the brain reacts to those changes. Sometimes the brain overcompensates for the hearing changes by creating sound, producing tinnitus.

Every tinnitus patient presents differently and that presentation influences treatment. Some patients may have had constant, unchanging tinnitus for 20 years caused by a loss of hearing. Often those patients do well with sound therapy and hearing devices.

Some patients may present with fluctuating tinnitus. One day the tinnitus may be quiet, another day it may be loud. This type of tinnitus can fluctuate based on the level of physiologic stress that day. “If you wake up with Tinnitus first thing in the morning, I can bet you didn’t sleep well the night before,” said Grisanti. “Our program is so successful because we look at you as a whole and optimize these conditions that can help bring that volume down.”

For more information on Dizziness, Tinnitus and Imbalance visit our website today and watch the full presentation below!

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


Unveiling of the Dr. Kinkel Executive Boardroom

On September 13, 2018 we dedicated our first floor boardroom to Dr. William Kinkel. Dr. Kinkel, one of the founders of Dent Neurologic Institute, has been an integral part of Dent’s success and legacy.

Dent’s story is rooted in a rich history. in 1962, Harry M. Dent, an entrepreneur and philanthropist in the Buffalo area, was diagnosed with Parkinson’s disease. At the time not much was known about the disease, with few options for treatment and virtually no clinical research trials.

In 1963, under the leadership of his son Harry M. Dent, Jr., the Dent Family Foundation elected to support the work of renowned neurologist, Dr. William R. Kinkel, and his efforts in treating Parkinson’s disease. The Foundation provided an endowment to establish the Dent Clinic at Millard Fillmore Hospital in Buffalo, New York. Dr. Kinkel was appointed as the clinic’s director. The initial focus was the stereotactic surgical treatment of Parkinson’s.

In 1968 the clinic was restructured into Dent Neurologic Institute, which more accurately reflected its growth and reputation. The next year, the Institute received FDA approval to begin regional clinical trials of the anti-Parkinson’s drug Levodopa, which revolutionized the treatment of the disorder. This was the first of many major clinical trials the Institute would conduct in the coming years.

Through Dr. Kinkel’s and the Dent Family Foundation’s leadership, Dent Neurologic Institute became a leader in the treatment of neurological diseases. Today with over 70 providers across 3 locations, treating 250,000 patients annually, we are proud to be the largest outpatient neurology practice in the country.


“Dr. Kinkel has given us more than we can thank him for today, he made us who we are. He made DENT what it is today…he taught us empathy, he taught us the patient comes first. We owe him everything.


– Dr. Laszlo Mechtler, DENT Medical Director