Motives For Diagnostic Referral
Some GPs referred patients to obtain diagnostic certainty, if it would have serious consequences for patients and their relatives:It has a lot of impact, such a diagnosis. So in that sense it is good that it is confirmed by a specialist.
They also mentioned the broader range of diagnostic tests that were available in the outpatient clinics:It gives some more information on where the gaps are, because they simply have more questionnaires, they do much more.
And in particular the neuropsychological examination, that simply adds more to what I can do.
Age was an important factor for the decision whether or not to refer. GPs tended to refer young patients with cognitive problems to exclude other causes for cognitive decline that could have important consequences for treatment or prognosis:Of course it is unusual when someone shows these symptoms at a young age. You want to exclude that there are other things that are important for the prognosis, so then youll refer sooner.
I have referred a young patient to the neurologist, who appeared to have Parkinsons disease.
The potential benefit of medication and the future prospects for this group of patients were also mentioned:For a young person it is a distressing disease, and that is of course terrible then you absolutely want to make a distinction, and then you want to refer them to the neurologist, who can, among other things, start medication.
Diagnosing Lewy Body Dementia: For Professionals
Lewy body dementia can be difficult to diagnose. Talking to both patients and caregivers helps doctors make a diagnosis. It is important to ask the patient and their care partners about any symptoms involving thinking, movement, sleep, behavior, or mood. Certain medications can worsen LBD symptoms be aware of all current medications and supplements the patient is taking.
Dementia with Lewy bodies is often hard to diagnose because its early symptoms may resemble those of Alzheimer’s disease or a psychiatric illness. As a result, it is often misdiagnosed or missed altogether. As additional symptoms appear, making an accurate diagnosis may become easier.
The good news is that doctors are increasingly able to diagnose LBD earlier and more accurately, as researchers identify which symptoms and biomarkers help distinguish it from similar disorders.
Visiting a family doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. If a persons primary doctor is not familiar with LBD, they may have patients seek second opinions from specialists, like a geriatric psychiatrist, neuropsychologist, or a geriatrician to help diagnose LBD. If a specialist cannot be found in your community, ask the neurology department at a nearby medical school for a referral. Neurologists generally have the expertise needed to diagnose LBD.
Difficult as it is, getting an accurate diagnosis of LBD early on is important so that a person:
S Doctors Take To Diagnose Dementia
Doctors typically go through 5 areas of evaluation to figure out whether or not someone has dementia. The doctor needs to check each area and document what they find.
1. Difficulty with mental functionsThis is usually evaluated with a combination of an office-based cognitive test and finding out about real-world problems by talking with their patient and people close to them.
2. Decline from previous level of abilityThis can be more difficult for a doctor to determine, so they need to talk with people who know the patient well to understand their previous abilities versus what they can do today.
For example, if a former accountant can no longer do basic math, thats a decline from their previous ability.
3. Impairment of daily life functionThis can also be tough for doctors to evaluate on their own.
So, the doctor will ask people close to their patient about what types of help the person is getting in their daily life and what problems family members have noticed.
4. Reversible causes of cognitive impairmentCertain conditions can cause temporary dementia-like symptoms.
Delirium can seem like Alzheimers or dementia and is usually caused by illness, infections, or a hospitalization and can last from weeks to months.
Other medical problems that interfere with thinking skills include medication side effects, thyroid problems, electrolyte imbalances, B12 deficiency, substance abuse, and other treatable health conditions.
You May Like: How Long Does Early Onset Alzheimer’s Last
Resistance To Visiting A Doctor
Some people may be resistant to the idea of visiting a doctor. In some cases, people do not realise, or else deny, there is anything wrong with them. This can be due to the brain changes of dementia that interfere with the ability to recognise or appreciate one’s memory problems. Others, with retained insight, may be afraid of having their fears confirmed.
Dealing with resistance to visiting the doctor
One of the most effective ways to overcome this problem is to find a physical reason for a visit to the doctor, preferably a check-up for a symptom that the person is willing to acknowledge, such as headaches or failing eyesight. Perhaps suggest an examination of the heart, a test for blood pressure or diabetes, or a review of long term medication. Another way is to suggest that it is time for you BOTH to have a physical check up. Any expressed anxiety by the person is an excellent opportunity to suggest a visit to the doctor. Be sure to provide a lot of reassurance. Calm, caring attitude at this time can help overcome the person’s very real worries and fears.
If the person will not visit the doctor:
- Talk with other carers who may have had to deal with similar situations
- Contact the Aged Care Assessment Team
Key Features Of Dementia
A person having dementia means that all five of the following statements are true:
- A person is having difficulty with one or more types of mental function. Although its common for memory to be affected, other parts of thinking function can be impaired. The 2013 DSM-5 manual lists these six types of cognitive function to consider: learning and memory, language, executive function, complex attention, perceptual-motor function, social cognition.
- The difficulties are a decline from the persons prior level of ability. These cant be lifelong problems with reading or math or even social graces. These problems should represent a change, compared to the persons usual abilities as an adult.
- The problems are bad enough to impair daily life function. Its not enough for a person to have an abnormal result on an office-based cognitive test. The problems also have to be substantial enough to affect how the person manages usual life, such as work and family responsibilities.
- The problems are not due to a reversible condition, such as delirium, or another reversible illness. Common conditions that can cause or worsen dementia-like symptoms include hypothyroidism, depression, and medication side-effects.
- The problems arent better accounted for by another mental disorder, such as depression or schizophrenia.
Recommended Reading: How Is Frontotemporal Dementia Different From Alzheimer’s
Diagnosing Vascular Dementia Diagnosing Vascular Dementia
A diagnosis of vascular dementia usually starts with a conversation with a GP. There is no single test for vascular dementia, and a diagnosis may be based on a combination of things.
Getting an early diagnosis of vascular dementia has many benefits. It means other conditions can be ruled out and it gives the person an explanation for their symptoms.
A diagnosis also gives a person access to treatment, advice and support, and allows them to prepare for the future and plan ahead.
What Is Dementia Symptoms Types And Diagnosis
On this page:
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.
You May Like: Does Diet Pop Cause Dementia
Mental Ability Tests To Diagnose Dementia
People with symptoms of dementia are given tests to check their mental abilities, such as memory or thinking.
These tests are known as cognitive assessments, and may be done initially by a GP.
There are several different tests. A common one used by GPs is the General Practitioner Assessment of Cognition .
Although these tests cannot diagnose dementia, they may show there are memory difficulties that need further investigation.
Most tests involve a series of pen-and-paper tests and questions, each of which carries a score.
These tests assess a number of different mental abilities, including:
- short- and long-term memory
- language and communication skills
- awareness of time and place
It’s important to remember that test scores may be influenced by a person’s level of education.
For example, someone who cannot read or write very well may have a lower score, but they may not have dementia.
Similarly, someone with a higher level of education may achieve a higher score, but still have dementia.
Different Types Of Memory Loss
There are three different types of memory loss as you age.
- Age-Associated Memory Impairment
#1. Age-Associated Memory Impairment
If you have difficulties with your memory, but can still do some of the following things listed below, you may have what is known as age-associated memory impairment.
- You struggle with your memory, but it does not disrupt your daily life.
- You can continue to complete tasks as you always have.
- You can learn and remember new things.
- You have no underlying medical conditions that are causing memory problems.
Age-associated memory impairment is a typical sign of aging. While you may struggle to remember things on occasion like where you placed your phone or a friends name for a minute, these are not signs of Dementia.
#2. Mild Cognitive Impairment
Mild Cognitive Impairment is a condition that falls between Age-Associated Memory Impairment and Dementia. You may experience memory loss, have trouble speaking or become disoriented at times. Still, these issues are not severe enough to interfere with your normal routine.
If you have mild cognitive impairment, you are at a higher risk of developing Alzheimers Disease or another type of Dementia.
#3. Dementia
If you are struggling with your memory loss and it affects your daily life, you may have Dementia. Some other signs may include:
If you see these signs, you may be in the early stages of Dementia, but the only way to confirm this is to see your doctor.
You May Like: How Fast Does Dementia Kill
Current Practice In Diagnosing Dementia
The remainder of this information will provide an overview of the diagnosis process and a guide to what happens after diagnosis.
It is important to remember that there is no definitive test for diagnosing Alzheimers disease or any of the other common causes of dementia. Findings from a variety of sources and tests must be pooled before a diagnosis can be made, and the process can be complex and time consuming. Even then, uncertainty may still remain, and the diagnosis is often conveyed as possible or probable. Despite this uncertainty, a diagnosis is accurate around 90% of the time.
People with significant memory loss without other symptoms of dementia, such as behaviour or personality changes, may be classified as having a Mild Cognitive Impairment . MCI is a relatively new concept and more research is needed to understand the relation between MCI and later development of dementia. However, MCI does not necessarily lead to dementia and regular monitoring of memory and thinking skills is recommended in individuals with this diagnosis.
How To Prepare For Your Appointment If You Think You Have Dementia
Suppose you think you may be living with Dementia and see signs of Dementia. In that case, you will want to make an appointment with your healthcare provider.
While you are waiting to see your doctor, write down any symptoms you are experiencing and any questions you may want to ask your doctor.
You want to make sure that you are honest regarding your evaluation and questionnaire that you fill out. The more information you can provide to your healthcare provider, the better they will understand your symptoms and give you a proper diagnosis with the symptoms that are present.
Also Check: How To Deal With Violent Dementia Patients
What Doctors Need To Do To Diagnose Dementia
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 older adults 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.
How You Can Help Move Biomarker Research Forward
The use of biomarkers is enabling scientists to make great strides in identifying potential new treatments and ways to prevent or delay dementia. These and similar advances have been possible only because of the thousands of volunteers who have participated in clinical trials and studies. Clinical trials need participants of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. Major medical breakthroughs could not happen without the generosity of research participants who essentially become partners in these scientific discoveries.
To find clinical trials and studies on Alzheimer’s and related dementias, visit the Alzheimers.gov Clinical Trials Finder
Recommended Reading: How Can You Test For Dementia At Home
What Are The Different Types Of Dementia
Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these diseases.
Types of dementia include:
- Alzheimers disease, the most common dementia diagnosis among older adults. It is caused by changes in the brain, including abnormal buildups of proteins, known as amyloid plaques and tau tangles.
- Frontotemporal dementia, a rare form of dementia that tends to occur in people younger than 60. It is associated with abnormal amounts or forms of the proteins tau and TDP-43.
- Lewy body dementia, a form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies.
- Vascular dementia, a form of dementia caused by conditions that damage blood vessels in the brain or interrupt the flow of blood and oxygen to the brain.
- Mixed dementia, a combination of two or more types of dementia. For example, through autopsy studies involving older adults who had dementia, researchers have identified that many people had a combination of brain changes associated with different forms of dementia.
Learn more about how researchers are using neuropathology to address questions and complexities of dementia diseases in Inside the Brain: The Role of Neuropathology in Alzheimers Disease Research.
Two Technologies That Can Make Diagnosing Dementia Easier For Doctors And Patients
With millions of older adults projected to develop Alzheimers in the next few decades, researchers are creating novel systems for diagnosing the disease
Every year, thousands of families are forced to grapple with a heart-wrenching realizationsomeone they love has dementia. In the United States alone, more than 5 million adults over the age of 65 live with dementia, and that number is projected to grow to 14 million by 2060. The most common form of dementia is Alzheimers disease, which is caused by changes in the brain that are currently irreversible.
With doctors expected to see an unprecedented number of dementia patients in the coming decades, Boston University researchers are developing new technologies to assist them in diagnosing, predicting, and monitoring cognitive changes.
Because dementia can cause symptoms that vary in different peopleincluding problems with memory, speech and communication, healthy reasoning, and other cognitive impairmentsdiagnosing it is a challenge for doctors. Two studiesone that uses artificial intelligence to predict dementia onset, and another that uses at-home technology to track a patients progressaim to help accurately diagnose a persons cognitive decline. Knowing whether a person has dementia or a different condition that is treatable can help doctors care for patients as quickly and efficiently as possible.
Recommended Reading: Does Being Bilingual Prevent Alzheimer’s
How Is Alzheimer’s Disease Diagnosed
Doctors use several methods and tools to help determine if a person with thinking or memory problems has Alzheimers disease. To diagnose Alzheimers, doctors may:
- Ask the person experiencing symptoms, as well as a family member or friend, questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
- Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
- Conduct tests of memory, problem solving, attention, counting, and language.
- Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
- Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to support an Alzheimers diagnosis or rule out other possible causes for symptoms.
Doctors may want to repeat these tests to help best determine how the persons memory and other cognitive functions are changing over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.
People with memory problems should return to the doctor every six to 12 months.