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How Can A Neurologist Help With Dementia

Providing Psychological And Emotional Support

Memory Loss and Dementia Explained with Dr. Anne Constantino

Another area where psychologists can intervene when someone has received a diagnosis of a neurodegenerative disorder is their emotional and mental well-being.

Like any diagnosis, dementia can create confusion, sadness, anxiety, and other disturbing emotions both in the diagnosed individual and in their family members.

They might experience an initial reaction of shock, followed by DENIAL and GRIEF.

These emotional states can be challenging to overcome, as individuals and their families are still adjusting to the new circumstances of their life.

In this respect, psychologists can provide strategies to manage THESE emotions.

And help those involved in the life of the person with dementia find useful coping strategies for challenging moments.

Dementia Alzheimer’s Disease And Memory Loss

Understandably, discovering that you have trouble with memory and thinking can be worrisome. You want answers and options. At the Cognitive Disorders Program, part of the Department of Neurology at the University of Michigan Health System, our multidisciplinary team of experts has the experience and cutting-edge resources to properly diagnose you and create a treatment plan allowing you the best quality of life possible.

We see patients with a wide variety of cognitive disorders, including:

  • Other disorders of cognitive impairment

Progress In Understanding White Matter Dementia

The dementias are most often considered to derive from cortical dysfunction, and in some cases subcortical gray matter damage can be implicated, but less well-appreciated is the potential of white matter disorders to produce dementia. The concept of white matter dementia has been proposed to signify a specific dementia syndrome that can be ascribed to the burden of cerebral white matter involvement from a wide range of neuropathologic states. Whereas neurologists know that diseases such as multiple sclerosis and leukodystrophies can cause dementia, a more commonand less clearscenario arises when the evaluation of older people with cognitive decline discloses WMH on MRI. A common interpretation is that these changes are related to small vessel narrowing and white matter ischemia, but their relevance to cognition remains incompletely understood.

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Which Dementia Is It

After detailed history taking and examination, the clinician may be confident which disease process is responsible for the symptoms. Often, however, the clinical picture will not be sufficiently distinctive to allow the clinician to be certain which type of dementia is responsible. For this reasonas well as the importance of never missing a treatable cause of dementiait is usually appropriate to arrange investigations.

What Doctors Need To Do To Diagnose Dementia

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Now that we reviewed the five key features of dementia, lets talk about how I or another doctor might go about checking for these.

Basically, for each feature, the doctor needs to evaluate, and document what she finds.

1. Difficulty with mental functions. To evaluate this, its best to combine an office-based cognitive test with documentation of real-world problems, as reported by the patient and by knowledgeable observers

For cognitive testing, I generally use the Mini-Cog, or the MOCA. The MOCA provides more information but it takes more time, and many seniors are either unwilling or unable to go through the whole test.

Completing office-based tests is important because its a standardized way to document cognitive abilities. But the results dont tell the doctor much about whats going on in the persons actual life.

So I always ask patients to tell me if theyve noticed any trouble with memory or thinking. I also try to get information from family members about any of the eight behaviors that are common in Alzheimers. Lastly, I make note of whether there seem to be any problems managing activities of daily living and instrumental activities of daily living .

Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first.

Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes additional evaluation.

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What Treatments Might A Neurologist Prescribe For Dementia

There are a few medications that are approved for the treatment of Alzheimer Disease. These include cholinesterase inhibitors .

These medications work by modulating neurotransmitters in the brain and have some modest symptomatic benefit in patients with dementia.

Another category of medication includes Memantine, which is an NMDA-receptor antagonist. This works by blocking a different neurotransmitter which may protect the brain.

This also has been shown to have very modest benefits.

Neurologists may prescribe medications to help certain symptoms of dementia, such as behavioral disturbances, hallucinations, sleep problems, depression, agitation, and aggression.

These may include antidepressants, antipsychotics and various other medications.

Nutrition, physical therapy and cognitive rehab are also things a neurologist may consider in the multidisciplinary approach to dementia care.

Tips For Visiting The Gp

  • Write down things you want to talk about before you go. It can be difficult to remember everything you want to say.
  • Make a note of anything important the doctor says. You might want to write down any medical terms, for example.
  • Ask the doctor to explain in simpler language if you do not understand what they are telling you.
  • If you have any customs or religious beliefs that may affect treatment, mention this to your GP.
  • Ring the surgery after the appointment if there is anything you forgot to ask. You may be able to speak to the doctor on the telephone rather than have to make another appointment.
  • Ask to see the named GP that has been allocated to you.

Seeing the same GP regularly should be better for you. Sometimes this will not be possible, depending on which doctor is available at the surgery.

How the GP can support a person with dementia

Information about the different kinds of support available from a GP for a person with dementia.

Recommended Reading: Neurotransmitter Alzheimers

Learn A Second Language

Speaking more than one language can protect against Alzheimers disease and other types of dementia, according to 2017 research published in Clinical Interventions in Aging. While no one is sure why a second language helps so much, Dr. Knopman theorizes that the effort to communicate bilingually is like a workout for the brain, helping preserve gray matter and neurons. If learning another language isnt something youre up for, you could opt for any of these 50 everyday habits that reduce your risk of dementia.

Personhood Relationships And Empowerment Promote Living Well

Reduce dementia risk AND improve thinking with the NEURO plan

In 2007 and 2008, the Alzheimers Association led a series of town hall meetings designed to listen to and directly engage with people diagnosed with dementia7 300 individuals living with dementia were interviewed. Rather than responding about the personal or functional impact of dementia, participants focused on poor interactions with physicians during and after diagnosis, as well as how the stigma of dementia changed the way they were treated by others after diagnosis.8 Participants perceived the social reaction of the medical community, loved ones, and society in general as more damaging to their well-being than the disease itself, highlighting the social impact of dementia beyond its effects on physical and cognitive function. The stigma of being diagnosed and the immediate implications for control and autonomy in everyday decisions were of primary concern to town hall participants.8

Reed and colleagues8 posit what they term a tragedy discourse, a negative lens through which dementia is typically considered, as the dominant frame for understanding dementia, perpetuated in media and popular culture. This paradigm emphasizes losses despite evidence that people living with dementia retain their selfhood,9 and may continue to be productive, often discovering previously unknown talents and abilities.10

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Prognosis And Multidisciplinary Care

ALS is a rare degenerative disorder of motor neurons of the cerebral cortex, brainstem, and spinal cord that results in progressive wasting and paralysis of voluntary muscles. The median age of onset is 55, and the disease has a slight male predominance. Fifty percent of patients with ALS die within three years of symptoms onset 90% of patients die within five years. Patients with bulbar-onset ALS are more likely to die sooner. Riluzole is the only FDA-approved disease-modifying therapy for patients with ALS. Studies have indicated that this drug extends median survival by two to three months.

In addition, data suggest that multidisciplinary care improves quality of life and survival in patients with ALS. Traynor et al found that survival increased by 7.5 months among all patients in multidisciplinary clinics patients with bulbar onset lived 9.5 months longer.

Developing A Treatment Plan

Receiving a dementia diagnosis can be frightening and overwhelming for everyone involved in the care of the individual.

Psychologists PROVIDE SUPPORT throughout the process of coping with dementia.

Since this degenerative disorder is also associated with behavioral and emotional symptoms, psychologists can help minimize the changes in mood and behavior associated with memory impairment.

They work with the care team and with the family members to design strategies that can be applied in the living environment of the person with dementia.

Such as putting procedures in place that allow the individual to function at their MAXIMUM capacity.

Some individuals who are diagnosed with dementia might experience hearing loss besides other symptoms. This makes communication with their family members even more difficult.

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Stage : Moderate Dementia

Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.

While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.

What To Expect At The Doctors Office

Neurological Conditions

At your doctors appointment, youll likely be screened for various health issues such as vitamin deficiencies, depression, and sleep disorders. Be prepared for questions about your family history, mood changes, sleep quality, medications that you take regularly, how often you drink alcohol, and if youve had any major life changes or injuries recently. Consider bringing someone with you, such as your spouse, who can help with answering questions about any behavioral or personality changes they have noticed.

To prepare for your appointment, it may be helpful to bring notes regarding your experiences with memory loss. Be sure to include details about when these problems started and how often you experience them. You can also ask a loved one to help you keep a symptom diary, or even use technology, like health monitoring apps, to help you keep track of your daily experiences.

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Can Dementia Be Prevented

Although dementia cannot be prevented, living a health-focused life might influence risk factors for certain types of dementia. Keeping blood vessels clear of cholesterol buildup, maintaining normal blood pressure, controlling blood sugar, staying at a healthy weight basically, staying as healthy as one can can keep the brain fueled with the oxygen and nutrients it needs to function at its highest possible level. Specific healthful steps you can take include:

  • Follow a Mediterranean diet, which is one filled with whole grains, vegetables, fruits, fish and shellfish, nuts, beans, olive oil and only limited amounts of red meats.
  • Exercise. Get at least 30 minutes of exercise most days of the week.
  • Keep your brain engaged. Solve puzzles, play word games, and try other mentally stimulating activities. These activities may delay the start of dementia.
  • Stay socially active. Interact with people discuss current events keep your mind, heart, and soul engaged.

Stage : Moderately Severe Dementia

When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:

  • Delusional behavior

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How To Persuade Your Parent To Get Tested

Your parent might be more aware of his or her memory problems than you realize. For example, Mom might be dropping hints that sheâs starting to struggle, but youâve ignored them because you might not want to accept that there could be a problem. If sheâs trying to subtly tell you that everything isnât OK, be supportive of getting things checked out rather than dismissive, says Teepa Snow, a registered occupational therapist and founder of Positive Approach to Care, a training, education and consulting company building a community of care for people living with dementia.

However, if youâre the one seeing signs of trouble and want to initiate a conversation with your parent, Snow suggests starting by asking a more general question. Try something like, âHow do you feel like youâre doing? Is everything as it has been or are there things that arenât the same?â

If your parent doesnât think anything is wrong and that thereâs no need to be tested, Snow recommends trying one of these approaches.

Reach out to a third party: Ask your parentâs primary care provider or even one of your parentâs friends to suggest that he or she get tested for dementia. Your parent might be more open to the suggestion if it comes from a professional or peer than from you, the child.

Let your parent know that youâre worried about her well-being and that youâre asking her to get checked out by a doctor as a favor to you.

How Pharmacy Can Provide Patient

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Each persons experience of mild cognitive impairment and dementia will be quite different. Pharmacists and pharmacy teams are well placed to assist in both the early identification of dementia, as well as to help patients manage their medicines.

Dementia

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Dementia is a collective term for diseases of the brain that can affect reasoning, perception and memory, and its incidence increases with age. Around one in six people aged 80 years and over are affected by dementia this means that people working with medicines in all sectors will frequently come into contact with patients with dementia, their families and carers.

In the UK, around 25% of adults admitted to an acute hospital have dementia, although not all will have received a formal diagnosis. A number of reasons exist for the lack of a formal diagnosis, including a reluctance by individuals to see their GP when problems arise, and the under-recognition of the need to refer patients for assessment and subsequent diagnosis by health and social care professionals. Two-thirds of patients living with dementia in the UK live in the community, while only a third live in a care home. Pharmacists and pharmacy teams are, therefore, well placed to assist in both the early identification of dementia, as well as to help patients manage their medicines. A recent feature published in The Pharmaceutical Journal examined the developing role that community pharmacy can play in medicines optimisation in dementia.

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What Is Dementia Symptoms Types And Diagnosis

Dementia is the loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person’s daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.

Dementia is more common as people grow older but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.

There are several different forms of dementia, including Alzheimers disease. A persons symptoms can vary depending on the type.

Memory Care: Can Visiting A Neurologist Help Fight Memory Loss

Early memory loss can be subtle enough to miss, and its easy to brush it off as a part of getting older. But its important to recognize that while some forgetfulness can be a normal part of aging, memory loss that impacts your life in serious ways is not something to shrug off its a sign that you should visit the doctor. The good news is that for many people, memory loss is reversible, and for those experiencing memory loss due to dementia, early treatment can help slow its progression.

As a senior living community providing memory care services, Melrose Gardens understands the importance of early intervention when it comes to memory loss. In this article, well discuss how visiting a doctor or specialist, such as a neurologist, can help in the fight against memory loss.

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Therapy Improves Quality Of Life For People With Dementia

Therapy alone and with medication can help improve dementia. We may recommend therapy as part of your loved ones treatment program.

Occupational therapists evaluate performance in different areas in patients with dementia to determine their strengths and impairments. Practitioners work with patients and family members in specific areas, such as avoiding falls. The goal is to compensate for impairments and adapt in ways that improve functioning.

Your provider may recommend other types of therapy to improve your loved ones daily life.

Pharmacy Support For Patients With Mild Cognitive Impairment Who Forget Their Medicines

Do Neurologists Treat Dementia?

Pharmacists and pharmacy teams can offer support to patients with mild cognitive impairment in a number of ways, some of which are included in the Greater Manchesters dementia friendly pharmacy framework.

Whether the support takes the form of providing extra help with prescription ordering, collection and delivery, helping find solutions to help with medicines adherence or signposting patients to additional services or organisations who may be able to provide more specialist help, it is important that the approach is individualised to each patient. Box 1 provides additional guidance on how pharmacists can support patients with mild cognitive impairment who forget their medicines in practice.

Box 1: How to support patients with mild cognitive impairment who forget their medicines in practice

  • Is continuity of supply a problem?
  • Is the patient forgetting to order?
  • Is the patient forgetting to take medicines?
  • Is the patient unable to remember that medicines have been taken?
  • Pharmacists should ask patients about their good days and bad days any solution to these problems has to work on the bad days.

2. Consider if there are any potentially reversible causes of confusion or poor memory present.

  • Examples include: history of alcohol use, signs of acute infection, anticholinergic drug therapy, hyponatraemia or recent head trauma
  • Pharmacists may need to refer patients to an appropriate practitioner.

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