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.
What Happens If A Doctor Thinks It’s Alzheimer’s Disease
If a primary care doctor suspects Alzheimers, he or she may refer the patient to a specialist who can provide a detailed diagnosis or further assessment. Specialists include:
- Geriatricians, who manage health care in older adults and know how the body changes as it ages and whether symptoms indicate a serious problem.
- Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems.
- Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans.
- Neuropsychologists, who can conduct tests of memory and thinking.
Memory clinics and centers, including Alzheimers Disease Research Centers, offer teams of specialists who work together to diagnose the problem. In addition, these specialty clinics or centers often have access to the equipment needed for brain scans and other advanced diagnostic tests.
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.
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Tips For Choosing A Medical Provider
Once youve developed a potential list of AD providers, its time to contact their office and determine if they could be the right doctor for your loved one. Examples of questions to ask on the first phone call can include:
- What insurance types do you accept?
- What types of services are offered for those with AD?
- Are there any special qualifications or behavioral needs your practice works with or doesnt work with ?
- How is the staff trained in AD and dementia? Do any support staff members have special credentials related to AD care?
Another deciding factor could be the level of experience the provider has in treating people with AD. Some seek board certification in gerontology or in their chosen medical field. This means the doctor has undergone continuing education and further testing to prove they have extensive knowledge on a particular subject.
Many medical practices will also offer a free meet and greet appointment during which you meet the medical provider and tour the office to ensure its the best fit for a loved one. You may also wish to ask if the provider can give you references or testimonials from their patients. Speaking to others can help you determine what it would be like to see this doctor on a regular basis.
Tips For Visiting The Gp
- Write down things you want to talk about before you go. It can be difficult to remember everything you want to say.
- Make a note of anything important the doctor says. You might want to write down any medical terms, for example.
- Ask the doctor to explain in simpler language if you do not understand what they are telling you.
- If you have any customs or religious beliefs that may affect treatment, mention this to your GP.
- Ring the surgery after the appointment if there is anything you forgot to ask. You may be able to speak to the doctor on the telephone rather than have to make another appointment.
- Ask to see the named GP that has been allocated to you.
Seeing the same GP regularly should be better for you. Sometimes this will not be possible, depending on which doctor is available at the surgery.
How the GP can support a person with dementia
Information about the different kinds of support available from a GP for a person with dementia.
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How To Choose The Best Healthcare Team
Your primary care physician can help you assemble your healthcare team and refer you to specialists for further evaluation and treatment as needed.
There are many primary care doctors who are comfortable with treating dementia, says Graff-Radford, This is especially true if they see a lot of older patients who have been diagnosed with Alzheimers.
Can Exercise Make A Difference
There is some preliminary evidence that exercise can improve cognitive skills in people with early-stage Alzheimers disease.
For a University of Kansas study, published in February 2017 in the journal PLoS ONE, subjects took part in a supervised exercise program involving 150 minutes of walking per week.
After six months, some but not all of the subjects performed better on tests measuring memory and thinking skills. These subjects also showed a slight increase in brain size.
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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.
Fdas Accelerated Approval Program
Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
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How Is Alzheimer’s Disease Treated
Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.
Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimers. However, it is important to understand that none of the medications available at this time will cure Alzheimers.
What Does A Neurologist Examine For A Dementia Patient
After taking a careful history of the symptoms, a neurologist will begin with a general physical examination.
Part of this includes the neurologic exam.
A neurologic exam contains six major components mental status exam, cranial nerve exam, motor exam, sensory exam, reflexes, and cerebellar exam.
Abnormalities on the neurologic exam may give the neurologist clues as to what the diagnosis is.
The mental status exam will assess for orientation, attention, memory, visuospatial function, and language. Some common tools are the MOCA and MMSE .
These are a short series of tasks a neurologist may ask you to fill out, and based on how you score, can help in categorizing the types of deficits and hint as to the type of dementia.
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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.
Neurologists: Do Seniors With Alzheimer’s Need One
When a loved one is diagnosed with dementia stemming from Alzheimers, understanding your options can be an emotional and difficult process. Though there is no cure, there are treatments available that can help reduce symptoms and help your loved one maintain their quality of life. While most experts agree that anyone with any form of dementia should see a specialist, there are several types to choose from. That can make it difficult to know what course of action to take.
One effective option is to visit neurologists specializing in dementia near you who can offer guidance. They can conduct a thorough neurological exam and recommend subsequent Alzheimers treatment. Combining a neurologists evaluation with the findings of other types of Alzheimers doctors near youpsychiatrists, psychologists and geriatricianscan help make the path to finding the best treatment for your loved one even clearer.
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Importance Of Getting An Early Diagnosis
Some people may be reluctant to go to the doctor when they notice problems they may wonder if theres any point in getting a diagnosis for a disease that has no cure. Or maybe they worry about losing their independence or fear not being able to care for themselves.
Today there is no cure for Alzheimers disease, but there are benefits to early detection.
To start with, the medications currently approved by the U.S. Food and Drug Adminsitration are more likely to be helpful early in the disease process.
Early intervention can delay progression to dementia if you have mild cognitive impairment, says , director of Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. We know that you can actually slow the rate of progression of the disease with aggressive multitargeted interventions, including traditional pharmacological therapies and lifestyle interventions, and we also give mild patients early access to clinical trials and research, Dr. Sabbagh adds.
For many, getting a diagnosis can also be a relief. In my experience, the vast majority of patients want to understand what is going on, says Jonathan Graff-Radford, MD, a behavioral neurologist at Mayo Clinic in Rochester, Minnesota. Its important to get a diagnosis as soon as you can so you can make plans for what might happen in the future, Dr. Graff-Radford adds.
- Misplacing things and losing the ability to retrace steps
- Trouble following or joining a conversation
What Are The Benefits Of An Early Alzheimer’s Diagnosis
Alzheimers disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimers, when they first notice symptoms, to severe, when they are completely dependent on others for care.
Early, accurate diagnosis is beneficial for several reasons. While there is no cure, there are several medicines available to treat Alzheimers, along with coping strategies to manage behavioral symptoms. Beginning treatment early in the disease process may help preserve daily functioning for some time. Most medicines work best for people in the early or middle stages of the disease. Learn more about Alzheimers medications.
In addition, having an early diagnosis helps people with Alzheimers and their families:
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What Is Mixed Dementia
It is common for people with dementia to have more than one form of dementia. For example, many people with dementia have both Alzheimer’s disease and vascular dementia.
Researchers who have conducted autopsy studies have looked at the brains of people who had dementia, and have suggested that most people age 80 and older probably have mixed dementia caused by a combination of brain changes related to Alzheimer’s disease,vascular disease-related processes, or another condition that involves the loss of nerve cell function or structure and nerve cell death .
Scientists are investigating how the underlying disease processes in mixed dementia start and influence each other. Further knowledge gains in this area will help researchers better understand these conditions and develop more personalized prevention and treatment strategies.
Other conditions that cause dementia-like symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.
Researchers have also identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:
How Is Dementia Diagnosed
A full dementia evaluation cannot be done in a quick office visit a family member or a close friend should accompany the patient to their primary physician or neurologist and be able to recount the history over the past several weeks, months, and even years.
The first steps include a complete history and physical examination, neurologic examination, and laboratory or imaging workup.
The history, or story of the patients symptoms, is crucial to the diagnosis.
A doctor might ask when the patient first noticed memory loss, how it has progressed, and what sorts of things he or she is not able to do anymore independently .
There are several tests available to help with the diagnosis of dementia, which will be discussed further below.
A full evaluation includes a physical and neurologic exam, laboratory testing, and most times imaging tests such as a CT scan or an MRI of the brain.
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When You Cant Be There
There may be times when you canât go to a doctor visit with your loved one and someone else takes them. If this happens, youâll want to be sure that you find out how it went.
Ask the person whoâll be with your loved one to take notes. They should write down the name and phone number of someone to call if you have questions. Also, have them ask the doctor for written instructions about any changes in care.
If needed, call the nurse or doctor after the appointment to get a report on how the visit went.
Learn About Neurology Specialists
Though many primary care physicians are able to make an initial diagnosis of dementia and provide basic care for memory-impairing diseases, working with a specialist in brain disorders and taking advantage of the physicians more extensive experience is a necessity for more thorough treatment. According to Dr. Piero G. Antuono, Silverado Brookfield Medical Director, those seeking the most thorough treatment and care of dementia are best served by consulting doctors with formal training and experience in geriatrics, neurology or psychiatry.
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Choosing The Right Doctor
Choosing a doctor is a very important decision, one that is best made when you are healthy. Not only do you want a doctor who is competent and well-trained particularly in the types of health issues you have but you also want one who gives you the time necessary to listen to and address your health problems or questions. A doctor who knows you and is familiar with your health concerns is a good starting point however, some experts believe that your long-time family physician is NOT the best person to go to for a diagnosis, because the familiarity he or she has with you or your loved one may affect the doctors medical judgment. If you have a family doctor that you know and trust, you may want to ask him or her for a referral to a doctor who specializes in diagnosing Alzheimers disease. Seek out a physician whose specialty is geriatrics, neurology, or clinical psychiatry, because these types of doctors are generally well-trained in the diagnosis of Alzheimers and other related dementias. Click here to use the Resource Locator tool to find physicians near you.
There are a number of things you can do to help ensure youre seeing the right doctor: