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Elder Voice

Newsletter on Eldercare and Caregiving

March, 2010
 
Diagnosing Dementia

Family members noticing a loved  one is having problems with memory are often confused and frightened by what  they see. They may wonder if it is the beginning of dementia.  This newsletter  discusses what dementia is and how it is diagnosed.

Dementia is a term for a cluster of symptoms caused by  death of brain cells. Memory loss is often, but not always, the major and first symptom. Other symptoms include changes in personality,  and difficulties with reasoning, judgment,  problem solving,  language, or controlling emotions.  Generally, dementia is irreversible. Eventually, the person with dementia will succumb to the underlying disease or  its side effects.

There are various types of dementia. Alzheimer's Disease is the most prevalent type. If someone is told they have dementia, they may or may not have Alzheimer's, but if they are told they have Alzheimer's, then they have one type of dementia.

It is important, when noticing symptoms, to have the patient diagnosed early and carefully, as not all symptoms of dementia may in fact be due to the disease.  There are other, often reversible conditions that can cause the same symptoms, such as urinary tract infections, medication mismanagement, pneumonia, thyroid dysfunction, low vitamin B12, and malnourishment or dehydration. Without an early and proper diagnosis, treatable conditions can progress or a person may be treated for a condition other than that which needs to be addressed. Early diagnosis also allows the person with dementia and family members more time to plan for the future when help  and care is needed.

Dementia is diagnosed through a multi-step process. At present,  conclusive diagnosis of dementia is only possible through an autopsy.  However accuracy   can be very high when a complete assessment is done by a competently trained professional.

A first step is a medical work up by a primary physician to rule out  the possible underlying, reversible  medical causes of symptoms. The  physician will order blood and urine tests.  She will look for  medication side effects, malnourishment, and other disorders. A history will be taken to look at other possible causes such as depression, anxiety, abuse,  alcohol or drug abuse, and other lifestyle factors. She  will usually do a brief verbal test such as the Mini Mental Status Exam (MMSE).

Although many tests can be done by a primary care physician, a referral to a  geriatrician or specialized dementia clinic  is often warranted to obtain a more certain diagnosis. Further assessments may include a neurological exam and brain imaging tests. At specialized diagnostic clinics there are  both physicians and support personnel  such as physio and occupational therapists, nurses, and social workers who  work with families and the person diagnosed.

Through brain imaging, tumours or other conditions may be found. These tests include a CT scan, an MRI (Magnetic Resonance Imaging) to examine position or volume of brain  tissue, or PET (Positron Emission Tomography) which produce two or three dimensional images of brain activity. A SPECT (Single photon Emission Computerized Tomography) scan can help to distinguish between the different possible types of dementia.

 
 

When faced with symptoms which appear to indicate a change or problem, family members should be prepared to act as an advocate to insure that  symptoms are taken seriously and the appropriate assessment is carried out. "It's just old age" is not an appropriate  response to concerns about memory loss or other concerns.

For 10 Signs of Alzheimer's Disease, click here.

For more on Diagnosing dementia, click here.

 
 
Cognitive Tests for Dementia

Professionals will often give verbal tests  in initial  examinations to determine dementia. These may include the following.

MMSE (Mini Mental Status Exam)  is a 30 point questionnaire that looks at orientation, short term memory,  attention and recall, spatial orientation, and following commands. It is the most commonly used test.

SLUMS (St Louis Mental Status) exam   is another 30 point exam, seen to be as reliable as the MMSE, but may be better for diagnosing MCI (Mild Cognitive Impairment), a type of  memopry impairment that often, but not always precedes dementia..

MOCA (Montreal Cognitive Assessment) is another 30 point test. It is also often used to screen for MCI. It screens for attention and concentration, executive functioning, memory and orientation

ECOG (Everyday Cognition) is a test filled out by someone close to a person, and tests for memory, language, factual knowledge (semantics), visuo-spatial abilities, planning, organization, and divided attention. It can be used to help diagnose dementia in very early stages.

Although these and other  tests are valid and reliable, they also have limitations.Results can vary by who is giving the test, where it is given, and by the education level, culture, and the degree of anxiety/comfort of the person taking it. The tests do not easily uncover problems in personality or emotional changes or in what is called executive function--planning, judgment, and insight, for example.


Dementia Education Series: Alzheimer's Society  of BC

 The Alzheimer's Society of BC is offering three - 3 hour sessions on:

  • Understanding Alzheimer's disease and Related Dementias
  • Creative Approaches to communicating with a person with Dementia
  • Problem Solving Challenging Behaviour
  • Changing Roles
  • Planning Ahead and Understanding the Health Care system
This is an excellent opportunity for family caregivers to learn effective ways to care for a person with Alzheimer's disease or a related dementia.

Please pre-register: call Kate at 604-742-4929

or email kcowell@alzheimerbc.org

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Diamond Geriatrics is a Geriatric Care Management, counselling, and consulting company based in Vancouver, BC. Call us at  604-874-7764 or visit our website: www.DiamondGeriatrics.com 

Types  of Dementia

There are many types of dementia. Here are the ones you will most often hear about:
 
1. Alzheimer's Disease often characterized by a gradual onset.
2.Vascular/Multi Infarct Dementia Dementia: caused by stroke or small brain infarcts called TIA (Transient Ischemic Attacks).
3. Parkinson's related dementia: one of the possible effects of Parkinson's disease.
4. Lewy Body Dementia: similar to Alzheimer's disease, with some Parkinson's like symptoms and with development of lewy bodies in the brain.
5. Frontotemporal Lobe dementia:an umbrealla term for a group of disorders which affect the frontal and temporal lobes of the brain, often characterized by impaired executive function and changes in personality.
6. AIDS related dementia
7. Pick's Disease is one of the frontotemporal lobe diseases.
8 Creutzfeld Jacob (Mad  Cow Disease) disease related dementia.
 

For more about the types of dementia click here  and here.


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