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How To Get A Parent Evaluated For Dementia

How Do I Know If My Senior Parent Has Dementia And Other Common Questions

Why your loved one doesn’t believe they have dementia- It’s NOT denial.

    The warning signs of dementia can be subtle at first, especially if your parent lives on the other side of the country. By the time the signs become obvious, your parent may have moderate to advanced dementia and need extensive care. Recognizing the warning signs early can help you encourage your parent to get a proper diagnosis, begin planning for the future, and implement lifestyle changes that keep your parent safe while making their life easier.

    Acknowledge The Conversation May Not Go As Planned

    You know you have good intentions, but your loved one may not be open or willing to discuss the changes you have noticed. They may be angry or defensive. Dont force the conversation. Take a break and plan to revisit the conversation later. If your loved one still refuses help, contact a medical professional.

    Listen For The Meaning Behind Their Words

    Feeling misunderstood is a very frustrating aspect of dementia. Become an active listener and provide encouragement. Give the person the time they need to express themselves.

    Try not to interrupt or jump in to finish their thoughts. Never brush off their feelings. Using the rules of improv with dementia can help. Things like listening fully, being in the moment, and going with the flow can all make communication go more smoothly no matter what stage of dementia they are in.

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    Future Directions In Diagnosis Research

    Considerable research effort is being put into the development of better tools for accurate and early diagnosis. Research continues to provide new insights that in the future may promote early detection and improved diagnosis of dementia, including:

    • Better dementia assessment tests that are suitable for people from diverse educational, social, linguistic and cultural backgrounds.
    • New computerised cognitive assessment tests which can improve the delivery of the test and simplify responses.
    • Improved screening tools to allow dementia to be more effectively identified and diagnosed by GPs.
    • The development of blood and spinal fluid tests to measure Alzheimers related protein levels and determine the risk of Alzheimers disease.
    • The use of sophisticated brain imaging techniques and newly developed dyes to directly view abnormal Alzheimers protein deposits in the brain, yielding specific tests for Alzheimers disease.

    Early Symptoms Of Dementia

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    Although the early signs vary, common early symptoms of dementia include:

    • memory problems, particularly remembering recent events
    • increasing confusion
    • apathy and withdrawal or depression
    • loss of ability to do everyday tasks.

    Sometimes, people fail to recognise that these symptoms indicate that something is wrong. They may mistakenly assume that such behaviour is a normal part of the ageing process. Symptoms may also develop gradually and go unnoticed for a long time. Also, some people may refuse to act, even when they know something is wrong.

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    Alzheimers Behaviors To Track

    For each of these behaviors, try to make note of the following:

    • Whether theres been a decline or change compared to the way your parent used to be
    • Whether this seems to be due to memory and thinking, versus physical limitations such as pain, shortness of breath or physical disabilities
    • When you or another person first noticed problems, and what you observed
    • What kinds of problems you see your parent having now

    If you dont notice a problem in any of the following eight areas, make a note of this. That way youll know you didnt just forget to consider that behavior.

    Have you noticed:

  • Signs of poor judgment? This means behaviors or situations that suggest bad decisions. Examples include worrisome spending, or not noticing a safety issue others are concerned about.
  • Reduced Interest in Leisure Activities? This means being less interested and involved in ones usual favorite hobbies and activities. You should especially pay attention if there isnt a physical health issue interfering with doing the activity.
  • Repeating Oneself? Has your parent started repeating questions or stories more than he used to?
  • Difficulty Learning to Use Something New? Common examples include having trouble with a new kitchen appliance or gadget. This can be a tricky one to decide on, given that gadgets become more complicated every year. But if youve noticed anything, jot it down.
  • Document And Share Dementia Behaviors With A Doctor

    Track signs of dementia using your phone or a journal. Its important to share specific examples with a doctor.

    If youre worried about upsetting a loved one, submit your observations to their physician privately in writing. Keep in mind that HIPAA authorization is not needed for you to share concerns with a parents health professional.

    Include details about:

    • When you first noticed dementia behavior
    • Specific dementia symptoms your parents show
    • How often they struggle and when it happens
    • Changes in their normal routine or behavior

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    Capacity To Make And Execute A Will

    The mental ability to make and execute a will is called “testamentary capacity.” Wills often are challenged when it is suspected the “testator” — the person who signed the will — lacked testamentary capacity at the time .

    Statutes and case law may vary among different jurisdictions, but testamentary capacity generally requires that the testator was aware of the following when signing the will:

    • The extent and value of their property
    • Those who are the natural beneficiaries of their estate
    • The disposition he or she is making

    If You Are Diagnosed With Dementia

    Moms mental assessment | Dementia

    Obtaining an early and accurate diagnosis can improve the quality of life for people with dementia.

    Talk to your doctor about treatment and ongoing assessment.

    Support and information is available through the National Dementia Helpline on 1800 100 500.

    Thanks to Associate Professor David Ames for reviewing this material.

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    Initial History And Physical Examination

    Concerns for early dementia may arise from the patient, the physician, or the patient’s loved ones. Physicians can recognize signs of worsening cognitive function from aberrant patient behaviors, such as missed appointments or vague answers to questions. A history to evaluate for cognitive impairment should include the input of a reliable informant because patients of ten have poor insight into their own functional status.25,26 The history should include education level, timeline of symptom presentation, and speed of progression.25,26 Table 2 outlines diagnostic clues for each cognitive domain.23,24 Early in the disease course, dementia often impairs instrumental activities of daily living, such as paying bills, balancing the checkbook, or remembering to take medications. Disease progression may further impair activities of daily living, including difficulty with eating, bathing, dressing, toileting, walking and transferring, and continence.

    Cognitive Domains Affected by Dementia and Associated Symptoms

    Complex attention

    Information from references 23 and 24.

    Cognitive Domains Affected by Dementia and Associated Symptoms

    Complex attention

    Information from references 23 and 24.

    Key Findings and Suggested Etiologies in Patients with Cognitive Impairment

    Alzheimer disease

    Key Findings and Suggested Etiologies in Patients with Cognitive Impairment

    Alzheimer disease

    Know The Signs Of Dementia

    Early diagnosis can help people with dementia plan for the future, and might mean they can access interventions that help slow down the disease. Being familiar with the signs of dementia can help people receive a diagnosis as early as possible.

    Early signs that a person might have dementia can include:

    • being vague in everyday conversations
    • memory loss that affects day-to-day function
    • short term memory loss
    • difficulty performing everyday tasks and taking longer to do routine tasks
    • losing enthusiasm or interest in regular activities
    • difficulties in thinking or saying the right words
    • changes in personality or behaviour
    • finding it difficult to follow instructions
    • finding it difficult to follow stories
    • increased emotional unpredictability.

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    Expert Advice Does Help

    Some seniors are so stubborn they will not believe anything you say. It is not until a professional doctor tells them the same thing you have said before, that they would consider it.

    Experts come in all forms, from doctors, social workers, priests, and nurses. It is their credibility that can convince an elderly parent to accept assisted living or help from a caregiver. Experts can explain the benefits of receiving support and different treatments. Seek out and use these professionals as they can quickly change the mood of your loved one.

    Merely speaking to an expert or professional can give a loved one the confidence in a correct answer. During this process, it is essential to utilize every tool and strategy you can.

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

    Caring for Aging Parents

    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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    Diagnosing Dementia And Alzheimers

    There are no definitive tests for dementia and Alzheimers. But visit the doctor if you suspect a loved one has memory loss.

    People are afraid of a diagnosis of dementia or Alzheimers. This is understandable. But, early diagnosis and intervention staves off institutionalization. It also helps someone prepare for future memory loss.

    Through a physical exam and a battery of tests, a doctor has a good idea of whether a patient has dementia or not.

    Do you have a loved one with dementia? With proper care, he can live a full life. Need help caring for a loved one with dementia or Alzheimers? Look into a memory care community today.

    Reduce The Need To Drive

    Individuals able to maintain an active life often adjust better to the loss of driving privileges. Following are some ways to reduce the need to drive:

    • Have groceries, meals, and prescriptions delivered to the home.
    • Arrange for a barber or hairdresser to make home visits.
    • Invite friends and family over for regular visits.
    • Arrange for family and friends to take the individual on social outings.

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    How To Talk To A Parent With Dementia

      Watching a parent, loved one or patient with dementia can be upsetting, especially as the disease progresses and it affects their ability to communicate successfully. Depending on what stage of dementia your parent is in, people with dementia may show forgetfulness, have trouble finding the right words when talking, and for severe cognitive decline, may need 24/7 care. Many ask how to talk to a parent with dementia because talking to a person with dementia can be challenging at times. Below we provide tips for communicating with dementia patients so you can improve your dementia communication with someone struggling from cognitive decline.

      Promoting Early Diagnosis Of Dementia

      Convincing someone they have dementia

      The early symptoms of dementia can include memory problems, difficulties in word finding and thinking processes, changes in personality or behaviour, a lack of initiative or changes in day to day function at home, at work or in taking care of oneself. This information does not include details about all of these warning signs, so it is recommended that you seek other sources of information. If you notice signs in yourself or in a family member or friend, it is important to seek medical help to determine the cause and significance of these symptoms.

      Obtaining a diagnosis of dementia can be a difficult, lengthy and intensive process. While circumstances differ from person to person, Dementia Australia believes that everyone has the right to:

      • A thorough and prompt assessment by medical professionals,
      • Sensitive communication of a diagnosis with appropriate explanation of symptoms and prognosis,
      • Sufficient information to make choices about the future,
      • Maximal involvement in the decision making process,
      • Ongoing maintenance and management, and
      • Access to support and services.

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      Ways To Find The Right Words To Say

      There are times in life when words escape us. This is one of them. You want to make sure your relative knows that you understand the news is difficult. Share that you are in this together. Be sure they know that people with dementia can continue to enjoy life.

      Discussing the dementia diagnosis will be the first of many conversations as the disease progresses. The ideas that follow may help you express yourself in an honest yet loving way, both in your first conversation and those to come.

      Montreal Cognitive Assessment And Saint Louis University Mental Status Examination

      The Montreal Cognitive Assessment and Saint Louis University Mental Status Examination are alternatives to the MMSE. Both are 30-point cognitive tests that take approximately 10 minutes to administer. The Montreal Cognitive Assessment is designed for persons scoring above 24 on the MMSE and has excellent sensitivity for detecting mild neurocognitive disorder it is also accurate in patients with Parkinson disease.29

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      Epidemiology And Risk Factors

      The overall prevalence of dementia is approximately 5%, increasing to 37% in persons older than 90 years.5 The lifetime risk of dementia is approximately 17%, with the incidence doubling each decade after 60 years of age.6 The median survival time after diagnosis of dementia is 4.5 years, but this varies based on age at diagnosis, ranging from 10.7 years for patients diagnosed in their 60s to 3.8 years for patients diagnosed in their 90s.7 Alzheimer disease accounts for 60% to 80% of dementia cases. Vascular dementia in isolation accounts for 10% of cases, but it commonly presents as a mixed dementia with Alzheimer disease. Lewy body dementia, Parkinson-related dementia, normal-pressure hydrocephalus, and frontotemporal dementia represent most of the remaining cases. Frontotemporal dementia, while accounting for less than 10% of total dementia cases, represents 60% of dementia cases in patients 45 to 60 years of age.2

      Older age remains the greatest risk factor for dementia.13 Other strong risk factors include family history of dementia personal history of cardiovascular disease, cerebrovascular disease, diabetes, or midlife obesity use of anticholinergic medications apolipoprotein E4 genotype and lower education level.1417 Other potential risk factors with weaker supporting evidence include smoking atrial fibrillation use of substances and medications such as alcohol, proton pump inhibitors, and benzodiazepines and head trauma.1822

      Some Questions You May Wish To Ask You Doctor Regarding Tests Used In Diagnosing Dementia

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      • What tests will be conducted?
      • Who will be performing the tests and how long will it take?
      • Should I prepare for the tests in any way?
      • Will any of the tests involve pain or discomfort?
      • Will there be any cost involved?
      • What follow-up will be necessary and who will follow up?
      • How will I be informed of the test results and the diagnosis?

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      Blessed Orientation Memory Concentration

      The Blessed Orientation Memory Concentration instrument is a shortened version of the BIMC with six questions assessing orientation to time, recall of a short phrase, counting backward, and reciting the months in reverse order.12 A weighted score of errors is calculated. As with the BIMC, making more than 10 errors is indicative of cognitive impairment.

      Involve Person In Discussions

      Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.

      If the individual is reluctant to talk about driving, ask the individual√Ęs physician or care manager to bring up the subject of driving during health care visits. A lawyer or financial planner may also be willing to discuss driving as part of the individual√Ęs legal and financial planning.

      Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will need to find the solutions that work best in their situation.

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      Understand The Financial Situation

      No matter what, caring for an older adult will cost money. Its a good strategy to estimate future costs so youll be prepared.

      Think about the medical care theyre likely to need, the cost of their potential living situation , and everyday costs like food, caregiving supplies, home safety modifications, etc.

      Once you have an idea of their financial position, youll know if theyll be able to afford the care they need or if theyll need financial help.

      Government programs, Medicaid, and other programs are available to help pay for long term care.

      You may want to consult an elder law attorney or financial planner to help you with things like qualifying for Medicaid.

      Regardless, its best to plan ahead so they wont get caught in a money crunch.

      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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