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How Does A Neurologist Diagnose Dementia

Questions To Ask After Getting A Dementia Diagnosis

Dr Hilary Archer: What dementia looks like to a neurologist

You should feel free to ask your healthcare provider any questions you have about dementia and your diagnosis. These 12 questions are a good place to start, but it’s normal to have several waves of questions as you begin to adjust. Take time to write them down as you think of them so that you can address them at your next practitioner’s visit.

Who Can Diagnose Dementia

Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.

If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.

Blood Tests To Check For Other Conditions

Your GP will arrange for blood tests to help exclude other causes of symptoms that can be confused with dementia.

In most cases, these blood tests will check:

  • liver function
  • haemoglobin A1c
  • vitamin B12 and folate levels

If your doctor thinks you may have an infection, they may also ask you to do a urine test or other investigations.

Read more about blood tests.

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Can A Primary Care Physician Diagnose You

Yes. A primary care physician needs to be able to diagnose Alzheimers particularly when theres not a neurologist practice nearby. Perhaps in some of the rural areas of the country.

But that diagnosis of Alzheimers from that PCP may be considered a preliminary diagnosis. Oftentimes the PCP will refer you to a neurologist to confirm their suspicions.

Is Alzheimers Diagnosed With A Blood Test

Pin by laurie robles on Alzheimers

The other biomarker test, uses either a blood sample or, more commonly, a cerebral spinal fluid sample. The CSF sample is obtained via a spinal tap.

We look for markers of Alzheimers disease in the blood and the spinal fluid samples. These are pieces of the plaques and tangles that might be circulating in the blood or spinal fluid.

Therefore, the patient can have a thinking and memory test, and then typically the physician will add on additional tests. One could be a PET scan of the brain and the other one could be a test of either the blood or cerebral spinal fluid.

Diagnosing Alzheimers disease is a process. And its typically a combination of these three approaches: Cognitive Testing, PET biomarkers and fluid either blood or spinal biomarkers.

In all cases, personal results are compared to norms. The person is compared to other healthy people in the population that are approximately just like them. Neurologists look at the levels of all of the things that they are measuring to determine if they think its Alzheimers disease.

And thats how a diagnosis goes.

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Refer Your Patient To A Neuropsychologist And Neurologist

Neuropsychometric testing with a neuropsychologist will often help to establish the type, degree, and progression rate of cognitive loss in your patient. If you suspect that a patient has non-reversible progressive dementia, an evaluation by a neurologist should be obtained.

Thats it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. Well help you make the right decisions for yourself and your patients.

Dementia With Lewy Bodies

Lewy bodies are neuronal inclusions composed of abnormally phosphorylated neurofilament proteins aggregated with ubiquitin and -synuclein that are deposited in brainstem nuclei, paralimbic, and neocortical areas. The clinical phenotype often involves visual hallucinations, parkinsonism, and fluctuating attention and alertness with intervals of lucidity. The visual hallucinations are typically well formed and detailed. Hallucinations occur in other modalities not uncommonly and delusions also are a feature. The cognitive profile reflects a combination of cortical and subcortical disease . There is cognitive slowing with impairment of frontal executive functions and attention. In addition there are pronounced visuospatial and memory problems implicating parieto-occipital regions. The presence of aphasia, agnosia, and apraxia may lead to confusion with AD. Along with the cognitive effects, DLB is associated with repeated falls and episodes of transient loss of consciousness.

Table 5

Cognitive features of Alzheimers disease , frontotemporal dementia , and dementia with Lewy Bodies

These cognitive impairments may develop before or after parkinsonism symptoms and signs including akinesia, rigidity, and tremor.

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Psychiatrists And Neurologists: Differences

Understanding the difference between psychiatrists and neurologists is perhaps easiest if considered in the context of the symptoms they treat. The brain is the most complicated, yet least understood organ in the body and central, as it is ultimately in charge of our bodies, including both voluntary and involuntary functions.

This analogy, although imperfect, may help in understanding the difference: Psychiatrists focus on and treat symptoms originating in the brain that lead to abnormal voluntary functions, i.e human behaviors, whereas neurologists focus on and treat symptoms originating in the brain that produce abnormal involuntary functions.

In the case of depression, for example, the patient will present with voluntary symptoms, like social isolation, increased or decreased sleep or weight and stopping activities they once found enjoyable. By contrast, a stroke patient will present with involuntary symptoms, such as blurred vision, paralysis, headache, inability to communicate verbally and involuntary movements.

At What Age Can You Test Someone For The Signs Of Dementia

These 3 doctors diagnose dementia

There is no one particular age that someone must meet before they can be assessed for signs of dementia, although dementia is more common in people over 65. Early-onset dementia can begin in people who are in their 30s, 40s, and 50s. Diagnosing dementia in its early stages is important as early treatment can slow the progression of symptoms and help to maintain mental functions.

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Who Else May A Person With Dementia See

A person with suspected dementia may come into contact with a range of health and social care professionals. Consultants usually operate within specialist teams, including nurses, psychologists, occupational therapists and social workers. Nurses who work with people with dementia, and those caring for them, include: community mental health nurses , who work in the community, providing treatment, care and support for people with mental health problems and dementia district or community nurses, who provide care and advice for people living at home and practice nurses, who work with doctors in GP practices.

Clinical psychologists, who often work with consultants in memory clinics, assess memory and learning abilities. Occupational therapists can advise people on ways of maintaining their independence including carrying out adaptations and using special equipment. Social workers may be involved in assessing someones need for care services and home care workers may be brought in to help with personal and other care. Physiotherapists may be asked to advise on exercise for people, particularly in the early stages of dementia. Dieticians may be asked to provide guidance on nutrition, poor appetite, weight loss or weight gain.

Referral To A Dementia Specialist

Dementia can be difficult to diagnose, especially if your symptoms are mild.

If the GP has been able to rule out other causes for your symptoms, they’ll refer you to a healthcare professional who specialises in diagnosing dementia, such as:

  • a psychiatrist with experience of treating dementia
  • a doctor specialising in elderly care
  • a doctor specialising in the brain and nervous system

The specialist may work in a memory clinic with other professionals who are experts in diagnosing, caring for, and advising people with dementia, and their families.

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Why Should I Get Diagnosed If Dementia Isn’t Treatable

Some people feel like they’d rather not know if they have dementia if there’s no cure available at this time. However, there are several benefits of an early diagnosis. It’s even possible that your symptoms could be from a reversible condition that, once treated appropriately, could improve. Most people would not want to miss that opportunity.

Even though receiving a dementia diagnosis is difficult, it can also help explain why you’ve been having a harder time with your memory or decisions lately. Some people report feeling relief in knowing the cause of these problems.

There’s also a benefit to knowing about your dementia so you can take the opportunity to make decisions for your future and communicate them to those around you. This is a gift to yourself and to your loved ones because it ensures that your choices and preferences are honored, and it also prevents your family members from having to guess about what you want.

Biomarkers For Alzheimer’s Plaques

Specialized Diagnostic Tests for Dementia or Alzheimers ...

Other research is looking at whether lab tests of biomarkers, such as the level of amyloid-ß and tau in blood or cerebrospinal fluid, can predict a susceptibility to dementia. However, the work is complicated by the fact that different forms of amyloid-ß and tau exist. The key is to correctly identify the toxic forms.

Finding biomarkers of dementia will be critical in early diagnosis and treatment. One large-scale study looking to do this is the Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing , a longitudinal study aimed at determining what biomarkers, lifestyle choices and cognitive abilities best predict the development of Alzheimers disease.

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Information For Your Doctor

Itâs a good idea to put together the following for your first appointment:

  • A list of symptoms — include everything youâre feeling, even if you donât think it could be related to dementia
  • Any sources of major stress or recent life changes
  • A list of all medications you take, including vitamins and supplements, and the dosage
  • A list of any questions you have

Memory And Thinking Tests To Identify Alzheimers Disease

In a person who is living a doctor diagnoses Alzheimers disease by administering a series of tests of memory and thinking performance. These tests are given one-on-one by a professionally qualified investigator.

The goal is to administer the test in the same exact way any person across the country would receive it. And then the scores of these tests are compared to what are called norms.

Norms are people who are about the same age, the same sex, the same background. So the results are compared to those scores to tell if the person is truly having memory and thinking problems.

These tests will be between 80 to 90 percent accurate. And a second opinion wont necessarily improve the chances of getting the correct diagnosis if they simply repeat the standard memory and thinking tests.

But, depending on where you are located, other tests may be available in addition to the learning and memory tests. Lets talk about these tests.

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Strategies For Coping With A Dementia Diagnosis

In some cases, dementia symptoms may also be caused by more than one medical condition, such as the case of mixed dementia. Mixed dementia is diagnosed when it’s suspected or known that two or more diseases are causing dementia, such as a combination of Alzheimer’s and vascular dementia.

If your healthcare provider determines that you don’t have dementia, you’ll likely feel a significant sense of relief. Understanding whatever it is that has caused you to have these symptoms of memory loss can be very helpful in moving forward and making lifestyle and treatment decisions that may improve your symptoms.

Keep in mind that the strategies for reducing your risk of dementia often overlap with improving your overall health.

Stage : Age Associated Memory Impairment

Dementia: Diagnosis and Assessment

This stage features occasional lapses of memory most frequently seen in:

  • Forgetting where one has placed an object
  • Forgetting names that were once very familiar

Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.

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Some Of The Commonly Used Cognitive Tests Include:

Mini-Mental Status Examination

This test is usually conducted by your doctor or specialist in their office and takes around 5 minutes to complete. The MMSE is the most common test for the screening of dementia. It assesses skills such as reading, writing, orientation and short-term memory.

Alzheimers Disease Assessment Scale-Cognitive

This 11-part test is more thorough than the MMSE and can be used for people with mild symptoms.

It is considered the best brief examination for memory and language skills.

It takes around 30 minutes and is usually conducted by a specialist in their office, or you may be referred to a psychologist for the test.

Neuropsychological Testing

This involves a number of very sensitive tests administered by a neuropsychologist .

A typical testing session will take at least 2 hours and may be conducted over more than one visit.

A variety of tests will be used and may include tests of memory such as recall of a paragraph, tests of the ability to copy drawings or figures and tests of reasoning and comprehension.

Radiological tests

Standard X-rays may be taken and those who smoke will commonly require a chest X-ray to rule out lung cancer, which may be causing a secondary brain tumour. \

Brain imaging techniques

Various brain-imaging techniques are sometimes used to show brain changes and to rule out other conditions such as tumour, infarcts and hydrocephalus these include:

Can Dementia Suddenly Get Worse

The progression of dementia depends on the underlying disease. Some diseases have a rapid progression. Others progress more slowly. Any sudden change with either slow or rapid progression should be evaluated for another cause. In most cases, changes with dementia may seem like they came out of the blue when they actually may have been slowly developing in the background. The best way to prepare for changes and manage expectations is through information. Your doctor and medical team will be a valuable resource. There are a variety of educational resources that are also available through the Alzheimer’s Association.

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What Is A Neurological Exam For Dementia

During a neurological exam, the physician will closely evaluate the person for problems that may signal brain disorders other than Alzheimers. The doctor will look for signs of stroke, Parkinsons disease, brain tumors, buildup of fluid in the brain, and other conditions that may impair memory or thinking.

What Treatments Might A Neurologist Prescribe For Dementia

Do Neurologists Treat 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.

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If The Diagnosis Is Dementia

Dementia is one of the health conditions that people are most afraid of.

A study by the Alzheimer’s Society has shown that more than half of people wait for up to a year before getting help for dementia symptoms, because they feel afraid. But an accurate and early diagnosis can have many benefits.

After you’ve had the necessary tests , your doctor should ask if you want to know your diagnosis.

They should explain what having dementia might mean for you and give you time to talk about the condition and ask questions.

Unless you decide otherwise, your doctor, or a member of their team, should talk to you and your family or carer about:

  • the type of dementia you have or, if it’s not clear, they should talk to you about being assessed again in the future
  • the symptoms and how the condition might develop
  • the treatments you might be offered
  • the name of a health or social care professional who will co-ordinate the different types of support you need
  • care and support services in your area, including support groups and voluntary organisations for people with dementia, their families and carers
  • advocacy services
  • how dementia will affect your driving or employment, if this applies to you
  • where you can get financial and legal advice

You should also be given written information about dementia.

Order Laboratory And Diagnostic Imaging Tests

Order blood tests such as a complete blood count , metabolic panel, liver function tests, vitamin B12 levels, and thyroid function tests to rule out metabolic causes.

Figure 3. In the diagnosis of dementia, order laboratory tests such as complete blood count, metabolic panel, liver function tests, vitamin B12 levels, and thyroid function tests to rule out metabolic causes of dementia.

As well, order magnetic resonance imaging for the brain to rule out structural causes of dementia, such as tumors, chronic subdural hematoma, NPH, or infarcts. Volumetric assessment of various anatomic brain structures is not currently considered to be of diagnostic value for dementia. Computed tomography scans of the brain can be acquired if the patient cannot undergo an MRI, but these are less sensitive to various pathologies.

Although employed in some centers, positron emission tomography scanning, CSF biomarker analysis, genotyping, and encephalography are not routinely recommended for the work-up of dementia.

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