When The Behavior Of Someone Close To You Changes Finding Out What The Underlying Cause Is Can Seem Daunting A Diagnosis However Can A Make A Difference In Your Loved Ones Quality Of Life
The earliest stages of dementia are tricky to diagnose and identify. At times, the person seems completely normal. They can function physically. They communicate. They can care for themselves. But loved ones know differently. They cant pinpoint whats wrong, but they know that something is not right, and the person doesnt always seem to be himself or herself.
When dealing with an unknown medical issue, the best remedy is to schedule a doctors visit. This is easier said than done, however, with people experiencing early stage dementia.Although they may be aware that they are having trouble remembering, they may also be afraid to find out what could be causing it.
Early dementia causes confusion and clouds rationality, making it much harder to negotiate a visit to the doctor. One of the biggest challenges is getting someone in the door, says Helena Chang Chui, MD, chair and professor of neurology at the Keck School of Medicine of USC and an internationally recognized Alzheimers disease expert.
Having helped patients and their families in this situation, Chui has the following recommendations:
Remember that the patients perception of time and reality are different from yours. They may think that an event that occurred 20 years ago happened yesterday and arguing the point wont help. Someone with memory loss is not always grounded in reality, Chui says. As a result, caregivers must be savvy in their reasoning.
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What Stage Has Dementia Reached
Its critical to know what your loved one may expect in the time to come if youve received an accurate diagnosis. Is this dementia classified into stages? What stage does a loved ones doctor feel dementia has progressed to? What brought them to these conclusions? Unfortunately, there seems to be no way to foresee how dementia will progress.
You need to know what to expect to figure out your next moves, for example, such as if you are able to provide the amount of assistance they need at home or if you want to explore other possibilties such as long term care, assisted living or memory care. Understanding how serious the dementia is, can help you prepare ahead and anticipate future needs. can help you prepare ahead and anticipate future needs.
You should also ask the diagnosing physician if you need to visit a geriatric specialist for further evaluation or care.
Questions Your Doctor May Ask
When you are preparing to meet with your healthcare provider, you may want to think about some of the questions your doctor may ask you. It is important to be as honest as possible with these answers.
- What symptoms are you experiencing?
- When did they start?
- Is there anything that makes them better?
- Does anything make them worse?
- Are they progressively getting worse or staying the same?
- Have you had to stop doing things you love or day-to-day activities?
- Is there a family history of genetic dementia? These include Huntingtons or Parkinsons?
- What medications are you currently taking?
- Have you had significant life changes or experienced more stress than usual?
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What Should I Know As A Caregiver
There is a lot that caregivers are expected to do for loved ones with dementia that it would take a different essay to cover. However, its critical to inquire early on about what you will need as the caretaker when your loved ones dementia advances.
Check with your doctor about local options that might help you as a caregiver. While youll be focused on providing for your loved one, dont forget to look after yourself and dont take things personally.
People might become confrontational or experience behavioral changes when they are having a difficult day, confused, or terrified. Its necessary to keep in mind that its the brain changes that are happening not the person. Seeking support from a support group of all other caregivers may be quite beneficial when coping with this element of caring for a person living with dementia.
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
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What Are Memory Clinics And Centers
Memory centers are essentially a one-stop shop for everything a patient and their family may need living day to day with Alzheimers disease. These clinics offer a multidisciplinary, comprehensive approach to care.
At these clinics youll find a number of specialists, including behavioral neurologists, neuropsychologists, and geriatricians. These centers provide comprehensive diagnostic and treatment services for Alzheimers disease and other types of dementia. These centers also offer access to physical and occupational therapists and social services.
Your primary care doctor may be able to refer you to a memory clinic in your area. Many large hospitals and medical centers have memory disorder divisions.
You might also find helpful information through the Alzheimers and Related Dementias Education and Referral Center , a service of the National Institute on Aging , which funds Alzheimers Disease Research Centers at major medical institutions across the United States. The ADRCs offer help with obtaining diagnosis and opportunities to volunteer to participate in clinical trials in addition to other services. You can find a list of ADRCs on the NIA website.
Tips For Talking With Your Doctor About Dementia
Your doctor can help answer the questions that you have about Dementia. You may want to know some helpful tips and things to expect.
Before your appointment
- Ask a family member or close friend to go to your appointment with you. They will help you remember the questions you want to ask and what the doctor tells you during the appointment. They can also share with the doctor things they have observed. Most of all, they can serve as emotional support for you if you need them during your appointment and after.
- Choose the best time of day for you. You will want to make an appointment at a time when you feel well-rested and alert.
- Write down any symptoms that you are experiencing that are giving you trouble.
- Write down any questions that you have for your doctor.
What to Bring with you to your appointment
You will want to be sure to bring the following information to your appointment.
- List of symptoms. Include when you or your loved ones first noticed them. Note if they have worsened over time or improved.
- Any medications or supplements that you are currently taking. This includes vitamins and over-the-counter medications.
- Personal and family medical history.
- List any questions that you may have.
During Your Appointment
While at the doctor, you will want to keep these questions in mind.
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What Are The Signs And Symptoms Of Dementia
Signs and symptoms of dementia result when once-healthy neurons, or nerve cells, in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.
The symptoms of dementia can vary and may include:
- Experiencing memory loss, poor judgment, and confusion
- Difficulty speaking, understanding and expressing thoughts, or reading and writing
- Wandering and getting lost in a familiar neighborhood
- Trouble handling money responsibly and paying bills
- Repeating questions
- Not caring about other peoples feelings
- Losing balance and problems with movement
People with intellectual and developmental disabilities can also develop dementia as they age, and recognizing their symptoms can be particularly difficult. Its important to consider a persons current abilities and to monitor for changes over time that could signal dementia.
Are The Online Self
The online self-assessments may help evaluate your current symptoms and cognitive abilities, they do not give you an official diagnosis, nor should you rely on these as an official diagnosis. Instead of taking an online assessment, we recommend scheduling an appointment with your doctor to express your current concerns and get an accurate diagnosis.
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Mental Cognitive Status Tests
These are usually conducted to evaluate memory, simple problem-solving abilities, and thinking.
The tests can be BRIEF or COMPLEX and intensive depending on what the doctor wants to achieve.
Complex tests are offered by professional neuropsychologists to evaluate judgment, executive function, language, and attention.
Alzheimer’s & Dementia Symptoms We Manage
Our neurology and neuropsychology experts provide compassionate, personalized care that can help to improve the quality of life of patients living with Alzheimer’s disease and dementia. Our specialists can diagnose and manage symptoms, including:
- Memory loss
- Impaired decision-making, reasoning, and judgment
- Communication problems
- Depression and other emotional disturbances
Procedures and Diagnostic Tests for Alzheimer’s Disease and Dementia. Our specialists offer a full range of neuropsychological tests to diagnose Alzheimer’s disease and dementia, including tests for:
- Attention span
- Organizing skills
- Mood and emotions
We also offer a full range of physical tests that may be used to rule out other medical conditions or diagnose Alzheimer’s disease or dementia, including:
- Imaging tests. Your doctor may order imaging exams, such as an X-ray, MRI, or CT scan, to check for problems.
- Blood or urine tests. Blood and urine tests can rule out other medical conditions that may cause dementia.
- Electroencephalogram . An EEG test uses electrodes attached to your scalp to record the electrical activity of your brain. For your convenience, our specialists perform diagnostic EEG tests in our office.
- Lumbar puncture . During a spinal tap, your neurologist will remove a sample of spinal fluid from your spinal canal to check for neurological conditions.
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What Is The Difference Between Normal Aging And Dementia
The first thing you can do is determine if the difficulty you are having with your memory is caused by normal signs of aging or from Dementia.
As we age, about 40% of us will experience memory loss after 65. This does not mean that all 40% have Dementia. This memory loss is relatively mild. It is usually fairly easy to still live your life without interruption or help from others.
It is estimated by the World Health Organization only five to eight percent of individuals over the age of 60 will have Dementia at some point in their life.
The reason for such a vast difference is that they are many different levels of memory loss because not all memory loss is associated with Dementia.
Understanding A Dementia Diagnosis
A Dementia diagnosis may take a long time to confirm. Healthcare providers want to ensure the diagnosis is accurate, so they may ask for additional tests and screenings.
This is because no specific test can give you a dementia diagnosis.
An official diagnosis will be provided, after your doctor has multiple test results, medical history, and the evidence they need to confirm that you are living with Dementia.
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Why Choose Upmc In Central Pa For Dementia And Alzheimer’s Disease Care
At UPMC, our neurology specialists provide expert diagnosis and manage memory, mood, behavior, and cognitive problems that are caused by Alzheimer’s disease and dementia. Our neurologists and neuropsychologists will work together to perform a complete assessment to evaluate several areas of brain function, including personality, memory, cognitive ability, emotions, problem-solving, and reasoning.
After you receive the results of your assessment, your neurology team will work closely with you and your loved ones to develop a personalized care plan. Although there is no cure for Alzheimer’s disease and dementia — and no way to slow down the progression of the disease — our specialists use the latest medications and therapies to help patients and caregivers manage symptoms such as depression, behavioral problems, and sleeplessness.
Is It Dementia Or Mild Cognitive Impairment
Sometimes, when an older person is having memory problems or other cognitive issues, they end up diagnosed with mild cognitive impairment.
Mild cognitive impairment means that a persons memory or thinking abilities are worse than expected for their age , but are not bad enough to impair daily life function.
The initial evaluations for MCI and dementia are basically the same: doctors need to do a preliminary office-based cognitive evaluation, ask about ADLs and IADLs, look for potential medical and psychiatric problems that might be affecting brain function, check for medications that affect cognition, and so forth.
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Know The Benefits Of Early Diagnosis
It is essential to understand the benefits of an Early diagnosis when living with Dementia. Understanding the benefits may help you see your doctor begin learning how to cope and live with this diagnosis. These benefits include:
- Your doctor will diagnose you with an accurate Dementia Diagnosis based on symptoms and testing.
- Become actively involved in future healthcare and personal decisions.
- Get more effective treatments.
- Focus on what is most important in your life.
- Make choices for your future, including legal and financial matters.
- Use and understand resources that are available to you.
- It gives your family time to understand the challenges and the progression of such challenges.
- You can raise awareness of Dementia while you still can.
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.
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At Your Appointment With The Specialist
It’s important to make good use of your time with the specialist. Write down questions you want to ask, make a note of any medical terms the doctor uses, and ask if you can come back if you think of more questions later. Taking the opportunity to go back can be very helpful.
The specialist may organise more tests. One of these might be a brain scan, such as a CT scan, or an MRI scan.
They may also do further, more detailed memory tests.
If the specialist is still not certain about the diagnosis, you may need to have further, more complex tests. But most cases of dementia can be diagnosed after these assessments.
Neurologist Or Memory Disorder Specialist
A neurologist is a specialist who is trained in nervous system disorders, especially issues with the brain, spinal cord, and peripheral nerves.2
As with most branches of medicine, neurologists can focus on different aspects of these disorders, or choose to concentrate their care on one disorder. This is something to consider when looking for a neurologist: ask them if they specialize in dementia or the care of Alzheimer’s patients.
In addition to a medical degree, neurologists complete an internship and then a residency in neurology that is at least three years long. If they decide to pursue further specialization like training in sleep medicine or want to focus on one disorder, they might have additional training after their residency.3
You might also see doctors labeled as memory disorder specialists. These can be neurologists, psychiatrists, psychologists, or geriatricians who specialize in diagnosing and treating dementia or other memory disorders.
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Key Points Of Working With Your Doctor
- It is important to choose the right doctor for you.
- There are many different types of dementia. It is important to see a doctor who has experience treating the type of dementia you are living with.
- Different doctors can help evaluate your memory and thinking problems. Typically, you will first visit with your PCP or primary care doctor. Other specialists that may be involved include Geriatrician, Geriatric Psychiatrists, Neurologists, and Neuropsychologists.
- Symptoms of dementia may vary based on the type of dementia that you are living with.
- You want to be prepared with your appointment with your doctor. Record your current symptoms, medications, and questions that you may have.
- Understand how a diagnosis is made. No single test can diagnose dementia. These assessments include medical history, cognitive testing, lab tests, and brain imaging.
- Know the treatments that are available to help manage your symptoms.
- Know what to expect at your follow-up visits with your doctor.
Resources
What Medicine If Any Do You Recommend
Medication can help with memory issues and alertness momentarily, but it wont stop the condition from progressing. If the dementia is mild or moderate, medications such as donepezil , rivastigmine , or galantamine may be used, as well as memantine if the dementia is moderate to severe.
Medication to treat heart issues can help individuals with vascular dementia slow the progression of their cognitive impairment. Inquire about any potential side effects and any negative responses to any medications, herbal treatments, or vitamins your love one is now using.
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