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
