Signs Your Parent Needs To Be Tested
Just because your parent might be starting to forget things every now and then doesnât mean Alzheimerâs disease or another type of dementia is the cause. However, itâs important to be on the lookout for changes that arenât a normal part of the aging process. According to the National Institute on Aging and Mayo Clinic, these are early signs of more serious memory problems:
- Repeating questions
- Mixing up wordsâusing the wrong word to identify something
- Taking longer to complete familiar tasks
- Getting lost in familiar area
- Not being able to follow directions
- Changes in mood or behavior
- Confusion about time, people and places
- Neglecting personal hygiene
Your parent should see a doctor if he or she is experiencing these problems. Itâs important for him or her to be tested to see if symptoms are due to Alzheimerâs, another type of dementia or something else entirely. Dementia-like symptoms can be caused by depression, sleep apnea, thyroid problems, vitamin deficiencies, medication side effects or excessive alcohol consumptionâall of which can be helped with treatment.
Although there is no cure for Alzheimerâs disease, an early diagnosis will allow your parent to get treatment that can lessen symptoms. Plus, it will give you and your parent more time to discuss what sort of care he or she wants and to make a plan to pay for that care.
Conditions With Symptoms Similar To Dementia
Remember that many conditions have symptoms similar to dementia, so it is important not to assume that someone has dementia just because some of the above symptoms are present. Strokes, depression, excessive long-term alcohol consumption, infections, hormonal disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.
What Is Dementia Symptoms Types And Diagnosis
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.
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Can Dementia Be Inappropriately Diagnosed In A Single Visit
Sadly, yes. Although its common for doctors to never diagnose dementia at all in people who have it, I have also come across several instances of busy doctors rattling off a dementia diagnosis, without adequately documenting how they reached this conclusion.
Now, often these doctors are right. Dementia becomes common as people age, so if a family complains of memory problems and paranoia in an 89 year old, chances are quite high that the older person has dementia.
But sometimes its not. Sometimes its slowly resolving delirium along with a brain-clouding medication. Sometimes its depression.
It is a major thing to diagnose someone with dementia. So although its not possible for an average doctor to evaluate with as much detail as the memory clinic does, its important to document consideration of the five essential features as listed above.
A Word About Clinical Trials
Taking part in a clinical trial may be an option worth your consideration. Start your research at a credible place such as the Alzheimers Disease Clinical Trials Database. Thisis a joint project of the National Institute on Aging and the U.S. Food and Drug Administration . It is maintained by the NIAs Alzheimers Disease Education and Referral Center.
To get the most from the time with your doctor, its helpful to be prepared. Your doctor will ask you a series of questions about your symptoms. Writing down information ahead of time will help you answer accurately.
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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.
Evaluation Of Suspected Dementia
NATHAN FALK, MD, and ARIEL COLE, MD, Florida Hospital Family Medicine Residency, Winter Park, Florida
T. JASON MEREDITH, MD, Offutt Air Force Base Family Medicine Residency, Offutt Air Force Base, Nebraska
Am Fam Physician. 2018 Mar 15 97:398-405.
Dementia is the fifth leading cause of death in Americans older than 65 years. The United States population is aging, with 46 million persons older than 65 yearsa number that is expected to double by 2060.1 Consequently, by 2050, the estimated number of Americans living with dementia will increase from 5 million to 14 million, and the estimated cost of dementia care will increase from $236 billion to $1 trillion.2 Early recognition of cognitive impairment is integral to patient counseling, advance care planning, assessment of secondary or reversible causes of impairment, and consideration of medical therapy. The U.S. Preventive Services Task Force and the American Academy of Family Physicians have concluded that current evidence is insufficient to assess the benefits vs. harms of screening for cognitive impairment in older adults.3,4
This article focuses on the evaluation of patients with suspected dementia, including diagnostic criteria, brief screening tests suitable for use during primary care office visits, and diagnostic testing .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Recommendations from the Choosing Wisely Campaign
BEST PRACTICES IN NEUROLOGY
FIGURE 1.
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Which Provider Is Best For Me
It is recommended that everyone with suspected dementia should see a specialist to receive a proper examination and diagnosis. There are many different kinds of medical professionals including primary care physicians, nurse practitioners, physicians assistants, neurologists, etc., and trying to find the right one can be a long and tedious experience. There are many different dementia-specific specialists:
- Geriatricians are primary care internists or family practitioners who specialize in complex conditions of older people. They can provide care for all of an older adults medical needs, but do not specialize in brain or memory problems.
- Geriatric psychiatrists specialize in the mental and emotional needs of older individuals. They conduct thorough memory, mood, sleep, and thinking evaluations, and are particularly good at assessing memory problems associated with life stress, depression, anxiety, excess drinking, or family conflicts.
- General neurologists and psychiatrists perform memory evaluations, but do not specialize in Alzheimers and may treat few people with dementia.
- Behavioral neurologists specialize in cognitive problems such as memory loss, and are very good at detecting subtle brain injuries such as a small stroke or an infection that may be causing the memory problems. They also conduct very thorough neurological and cognitive exams.
Talking With A Doctor
After considering the persons symptoms and ordering screening tests, the doctor may offer a preliminary diagnosis or refer the person to a Cognitive Dementia and Memory Service clinic, neurologist, geriatrician or psychiatrist.Some people may be resistant to the idea of visiting a doctor. In some cases, people do not realise, or else they deny, that 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 the changes occurring. Others have an insight of the changes, but may be afraid of having their fears confirmed.One of the most effective ways to overcome this problem is to find another reason for a visit to the doctor. Perhaps suggest a check-up for a symptom that the person is willing to acknowledge, such as blood pressure, or suggest a review of a long-term condition or medication.Another way is to suggest that it is time for both of you 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. A calm, caring attitude at this time can help overcome the person’s very real worries and fears.Sometimes, your friend or family member may refuse to visit the doctor to ask about their symptoms. You can take a number of actions to get support including:
- talking with other carers who may have had to deal with similar situations
- contacting your local Aged Care Assessment Team
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Should I See A Psychiatrist Or A Neurologist
If you suspect that a loved one is experiencing symptoms of dementia, you may be unsure what kind of professional to consult. You will definitely want a specialist to get an accurate assessment, but with both psychiatrists and neurologists available, how can you know which one is best?
Key Symptoms Of Dementia
Dr. Kernisan describes the 5 issues that people with dementia typically experience:
- Difficulty with one or more types of mental function, like learning, memory, language, judgement
- Problems that are a change compared to the persons usual abilities
- Problems that make it difficult for them to manage everyday life responsibilities, like work or family
- Problems that arent caused by another mental disorder, like depression
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Cognitive Tests For Patients Who Screen Positive On Initial Testing
Patients who screen positive for cognitive impairment on brief screening tests should be evaluated further to quantify the degree of impairment.29 A variety of tools are available for this purpose, but only some are practical for the office setting. The following brief cognitive tests have limited sensitivity and specificity, particularly in patients with high intelligence and education levels. Physicians should consider referral for neuropsychiatric evaluation if a patient has normal findings on brief cognitive tests but cognitive impairment is still strongly suspected.
Is It Important To Diagnose Dementia What Is Involved What Can Doctors Do
In this article, we look at the tough issues relating to diagnosis. It may take time, and some tests may be involved. But for most people, getting a clear diagnosis is a vital first step towards getting good support for the years ahead.
Facing a dementia diagnosis
It is hard to face going through any diagnosis process or to try to coax a loved one to do so. And when it comes to dementia, it is especially hard. There is still a lot of stigmas associated with dementia. Embarrassment and fear make people avoid talking about the topic, let alone taking any action on it.
Many people will have lived with a strange sense of something being wrong for some time months or even years. They know they are having difficulties, but the reason for them is unclear. Family members and friends may suspect there is something wrong too, but feel unsure whether it is worth pushing for further investigations.
Over recent years, there is a growing consensus that it is a basic right for people living with dementia to be given clear information about the illness they are living with. This is accepted for any other illness so why not dementia? So yes, it is important to diagnose dementia.
In some situations, the person with suspected dementia may have a clearly stated wish not to know the diagnosis this is also their right and needs to be respected.
Have the tests and scans
Consider the treatment options
Plan ahead
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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
If Youre Worried About Possible Dementia
Lets say youre like the man I spoke to recently, and youre worried that an older parent might have dementia. Youre planning to have a doctor assess your parent. Heres how you can help the process along:
- Obtain copies of your parents medical information, so you can bring them to the dementia evaluation visit. The most useful information to bring is laboratory results and any imaging of the brain, such as CAT scans or MRIs. See this post for a longer list of medical information that is very helpful to bring to a new doctor.
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An Aging Population A Rapidly Growing Toll
The toll of Alzheimers disease and other dementias is high and rapidly growing as the population ages. Dementia affects approximately 7 million America and is projected to grow to nearly 12 million over the next 20 years, driven by an aging population and increased life expectancy. The research team pointed to a recent Alzheimers Association survey that found only half of seniors are being assessed for dementia despite the fact that screenings are now reimbursable services.
The researchers note that low rates of dementia specialist care are consistent with recent findings about regional U.S. neurologist shortages.
The study authors explain that their results dont answer the question of whether or not increasing use of dementia specialist health care should be a policy goal. They say use of specialist services may increase health care costs and, without enough evidence that they improve health outcomes, they may not be a cost-effective approach to dementia care.
Non-specialists and specialists may be complementary in dementia diagnosis and care, Zissimopoulos said. General practioners and other nondementia specialists play an important role in screening because often they are the first point of contact, while specialists are key to making finer distinctions across dementia subtype.
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
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When To Visit A Neurologist For Dementia
Caring for an older adult who has Alzheimers disease or another form of dementia requires a team approach that includes physicians, social workers, care coordinators and other specialists. It takes a dedicated care team to ensure the health and longevity of affected seniors and to help relieve stress for caregivers.If your senior loved one has recently been diagnosed, the first step is to decide on a course of treatment. While there is no cure for Alzheimers or dementia, there are steps you can take that may help to delay the progression of your family members disease. During this time, you will likely work with a variety of medical professionals to coordinate your loved ones care. It is important to understand the role and function of each of these specialists.
Begin by developing a strong relationship with your seniors primary care physician. They will act as the care teams quarterback, ultimately responsible for managing medications and therapies, monitoring for any conflicting treatments or side effects, and helping to assemble other specialists.Another key member of your loved ones dementia care team will be the neurologist. These specialists are trained in diagnosing, treating and managing disorders of the brain, nervous system and spinal cord. Many neurologists also have specialized training in one area of neurology such as stroke, epilepsy or dementia.
When to See a Neurologist
Nfl Retired Players Agree To End Race
PHILADELPHIA — The NFL and lawyers for thousands of retired NFL players have reached an agreement to end race-based adjustments in dementia testing in the $1 billion settlement of concussion claims, according to a proposed deal filed Wednesday in federal court.
The revised testing plan follows public outrage over the use of “race-norming,” a practice that came to light only after two former NFL players filed a civil rights lawsuit over it last year. The adjustments, critics say, may have prevented hundreds of Black players suffering from dementia to win awards that average $500,000 or more.
The Black retirees will now have the chance to have their tests rescored or, in some cases, seek a new round of cognitive testing, according to the settlement.
“We look forward to the court’s prompt approval of the agreement, which provides for a race-neutral evaluation process that will ensure diagnostic accuracy and fairness in the concussion settlement,” NFL lawyer Brad Karp said in a statement.
The proposal, which must still be approved by a judge, follows months of closed-door negotiations between the NFL, class counsel for the retired players and lawyers for the Black players who filed suit, Najeh Davenport and Kevin Henry.
The vast majority of the league’s players — 70% of active players and more than 60% of living retirees — are Black. So the changes are expected to be significant, and potentially costly for the NFL.
In the meantime, the Gordons and other NFL families wait.
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