How Is Dementia Diagnosed And Evaluated
Dementia diagnosis uses a variety of tests to rule out other, treatable conditions such as depression, vitamin B12 deficiency, hydrocephalus;and hypothyroidism. Physical and neurological examinations and cognitive testing are usually part of the analysis.
Brain imaging is a useful complement to laboratory tests to rule out other treatable conditions such as brain tumor. Your doctor may order one of the following imaging tests:
MRI of the head uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of the brain to detect brain abnormalities and diagnose conditions in the brain. Sometimes contrast material is injected into an arm vein to enhance the images. Head MRI may also reveal whether a stroke has recently occurred. See the Safety page;for more information about MRI. In many cases the physicians may order a second MRI to assess changes that have occurred in the interval.
Brain functional magnetic resonance imaging uses MR imaging to measure blood flow and oxygen changes that take place in an active part of the brain. fMRI can be used to help assess how brain function has been impacted by stroke, trauma or degenerative disease such as Alzheimer’s. However, its use as a diagnostic test is limited in dementia.
What Are The Causes Of Lewy Body Dementia
The precise cause of LBD is unknown, but scientists are learning more about its biology and genetics. For example, we know that an accumulation of Lewy bodies is associated with a loss of certain neurons in the brain that produce two important chemicals that act as messengers between brain cells . One of these messengers, acetylcholine, is important for memory and learning. The other, dopamine, plays an important role in behavior, cognition, movement, motivation, sleep, and mood.
Scientists are also learning about risk factors for LBD. A risk factor is something that may increase the chance of developing a disease. Some risk factors can be controlled while others cannot. Age is considered the greatest risk factor. No specific lifestyle factor has been proven to increase one’s risk for LBD.
Other known risk factors for LBD include certain diseases and health conditions, particularly Parkinson’s disease and REM sleep behavior disorder, which have been linked to a higher risk of LBD.
Having a family member with LBD also may increase a person’s risk, though LBD is not considered a genetic disease. Variants in three genes APOE, SNCA, and GBA have been associated with an increased risk, but in most cases, the cause is unknown.
Cognitive Symptoms Of Lewy Body Dementia
LBD causes changes in thinking abilities. These changes may include:
- Visual hallucinations, or seeing things that are not present. Visual hallucinations occur in up to 80 percent of people with LBD, often early on. Nonvisual hallucinations, such as hearing or smelling things that are not present, are less common than visual ones but may also occur.
- Unpredictable changes in concentration, attention, alertness, and wakefulness from day to day and sometimes throughout the day. Ideas may be disorganized, unclear, or illogical. These kinds of changes are common in LBD and may help distinguish it from Alzheimer’s disease.
- Severe loss of thinking abilities that interfere with daily activities. Unlike in Alzheimer’s dementia, memory problems may not be evident at first but often arise as LBD progresses. Other changes related to thinking may include poor judgment, confusion about time and place, and difficulty with language and numbers.
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How Is Ftd Diagnosed
FTD can be hard to diagnose because the symptoms are similar to those of other conditions. For example, bvFTD is sometimes misdiagnosed as a mood disorder, such as depression. To make matters more confusing, a person can have both FTD and another type of dementia, such as Alzheimer’s disease. Also, because these disorders are rare, physicians may be unfamiliar with the signs and symptoms.
To help diagnose frontotemporal dementia, a doctor may:
- Perform an exam and ask about symptoms
- Look at personal and family medical history
- Use laboratory tests to help rule out other conditions
- Order genetic testing
- Conduct tests to assess memory, thinking, language skills, and physical functioning
- Order imaging of the brain
A psychiatric evaluation can help determine if depression or another mental health condition is causing or contributing to the condition. Only genetic tests in familial cases or a brain autopsy after a person dies can confirm a diagnosis of FTD.
Researchers are studying ways to diagnose FTD earlier and more accurately and to distinguish them from other types of dementia. One area of research involves biomarkers, such as proteins or other substances in the blood or cerebrospinal fluid which can be used to measure disease progression or the effects of treatment. Researchers are also exploring ways to improve brain imaging and neuropsychological testing.
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.
The five most common forms of dementia are:
- 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.
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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.
Dementia Care Tips From Experienced Caregivers
Caring for someone with dementia isnt intuitive and doesnt come naturally. Theres a lot to learn, but you dont have to figure everything out the hard way.
In a helpful article at Verywell, social worker Esther Heerema shares 12 dementia care tips that caregivers have learned and wished theyd known sooner.
This advice isnt meant to add pressure or expectations to your already tough job. Theyre tips from caregivers who have been there and done that that can lighten your load, reduce stress, and help you cope with the challenges.
Here, we share highlights from Esthers article along with some of our own insights.
1. Its not worth it to argue with someone who has dementiaAlzheimers and dementia causes your older adults brain to malfunction. When they say things that dont make sense or are clearly untrue, they believe what theyre saying because its what their brain is telling them.
Its frustrating to hear things that arent true and instinctive to try to correct or remind. But that will only lead to both of you arguing or getting upset. And you simply cant win an argument with someone who can no longer use reason or logic consistently.
2. Ignoring symptoms wont make them go awayWhen you notice your older adult struggling with memory, thinking, or judgement, its scary to think that they might have dementia. Because it can be so hard to accept, many people hope that the symptoms will go away on their own or that theyre mistaken.
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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
Treatment As Dementia Gets Worse
The goal of ongoing treatment for dementia is to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.
Routine follow-up visits to a health professional are necessary to monitor medicines and the person’s level of functioning.
Eventually, the family may have to consider whether to place the person in a care facility that has a dementia unit.
Taking care of a person with dementia is stressful. If you are a caregiver, seek support from family members or friends. Take care of your own health by getting breaks from caregiving. Counselling, a support group, and adult day care or respite care can help you through stressful times and bouts of burnout.
Read Also: How Fast Does Dementia Kill
Treating Movement Symptoms In Lewy Body Dementia
LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.
People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.
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.
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What If The Gp Wont Make A Referral To A Memory Service Or Clinic For A Specialist Assessment
If you are experiencing difficulty getting a diagnosis, or if you have questions you cant get answered, well take the time to really understand the problem, and give you the expert support you need to tackle it. Please call our specialist dementia Admiral Nurses on our Helpline on 0800 888 6678 or email .
Alzheimers / Dementia Testing Alternatives
Despite the lack of an FDA-approved blood test, families who suspect their loved one may have Alzheimers have a well-trod, if meandering, path to a diagnosis. To begin the process, there are online tests for Alzheimers that can be downloaded, printed, completed and taken to your doctor, and even some interactive tests that might provide immediate results. However, these online tests do not actually test for Alzheimers or dementia. Instead, they offer families answers to these questions: Are my concerns about my loved one justified?Is this just normal aging or is there something more going on? Officially, the tests are looking for Mild Cognitive Impairment . These tests are not definitive, but they can help a family figure out what their next step should be.
If a doctor suspects a patient may have Alzheimers, there are more definitive approaches. Brain scans and tests on extracted spinal fluid when coupled with multiple physicians consultations can make a diagnosis of Alzheimers with upwards of 90 percent accuracy. Families should expect their loved one to be evaluated by a neurologist, a psychiatrist, and very likely a psychologist as well. Since Alzheimers is so common among the elderly, a diagnosis is less about finding a condition which fits and more about eliminating other possibilities.
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What Is Dementia And What Causes It
Dementia is a syndrome that causes a person to develop difficulty and problems with their memory or their ability to think. Unlike the normal changes that happen in a persons memory and thinking over time, dementia affects someones ability to function in their daily life activities and their normal routine .There are different causes of dementia. These causes are typically underlying neurological conditions . One common cause of dementia is Alzheimers disease. Other causes include diseases that impact brain blood vessels. For example, strokes may cause what is commonly termed Vascular Dementia. Some causes include Lewy Body Disease and Parkinsons disease.
How Is Vcid Treated
Vascular contributions to cognitive impairment and dementia are often managed with drugs to prevent strokes or reduce the risk of additional brain damage. Some studies suggest that drugs that improve memory in Alzheimer’s might benefit people with early vascular dementia. Treating the modifiable risk factors, such as high blood pressure, can help prevent additional stroke.
For more information about vascular dementia and VCI, see NIA’s list of resources.
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What Are The Benefits Of An Early Alzheimer’s Diagnosis
Early, accurate diagnosis is beneficial for several reasons. Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying Alzheimers process cannot be stopped or reversed.
Having an early diagnosis helps people with Alzheimers and their families:
What Are The Symptoms
Usually the first symptom is memory loss. Often the person who has a memory problem doesn’t notice it, but family and friends do. As dementia gets worse:
- You may have more trouble doing things that take planning, like making a list and going shopping.
- You may have trouble using or understanding words.
- You may get lost in places you know well.
Over time, people with dementia may begin to act very differently. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing.
Later, they cannot take care of themselves. They may not know where they are. They may not know their loved ones when they see them.
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Alzheimers Blood Tests Available In The Future
Another test thats shown promise is called the Simoa that also tests for proteins in blood plasma. Its the same idea as other blood tests: identify biomarkers in the blood that can usually only be seen via expensive or difficult exams including PET brain scans, MRIs, and spinal taps. The specific protein Simoa can detect is called ptau181, and has been linked to the changes caused by dementia in the brain.
In studies, the Simoa was found to be as good at predicting the development of dementia as PET scans and a spinal tap, without the cost, pain, or radioactivity associated with those tests. And the test can also detect upcoming dementia-caused brain changes in both the short and longer terms.; Right now, this technology is used by researchers to identify people who are good candidates for clinical trials. It is not yet available for most patients.
Treatment Of Behavior And Mood Problems In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Medications are appropriate if the behavior interferes with the person’s care or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of time is recommended.
The first step is to visit a doctor to see if a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers , and constipation can worsen behavioral problems and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-anxiety medicines can actually increase anxiety in people with LBD. Review your medications with your doctor to determine if any changes are needed.
Antidepressants can be used to treat depression and anxiety, which are common in LBD. Many of them are often well tolerated by people with LBD.
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