An 86 Year Old Man Falls Is Unable to Get Up His Son Helps Him Up and Her Is Able to Walk Again

"Medico, do you diagnose dementia? Because I demand someone who tin can diagnose dementia."

A homo asked me this question recently. He explained that his 86 yr-old male parent, who lived in the Bay Expanse, had recently been widowed. Since and so the father had sold his long-time home rather quickly, and was hardly returning his son's calls.

The son wanted to know if I could make a housecall. Specifically, he wanted to know if his father has dementia, such as Alzheimer's affliction.

This is a reasonable business organisation to have, given the circumstances.

However, it'south not very probable that I — or any clinician — will be able to definitely diagnose dementia based a unmarried in-person visit.

Simply I get this kind of request fairly frequently. So in this mail service I desire to share what I often find myself explaining to families: the basics of clinical dementia diagnosis, what kind of data I'll need to obtain, and how long the process can take.

At present, annotation that this post is non near the comprehensive arroyo used in multi-disciplinary memory clinics. Those clinics take actress time and staff, and are designed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cerebral problems in people who are relatively immature.

Instead, in this postal service I'll be describing the businesslike approach that I apply in my clinical practice. It is adapted to real-world constraints, meaning information technology can be used in a primary care setting. (Although similar many aspects of geriatrics, it'southward challenging to fit this into a fifteen minute visit.)

Does this older person take dementia, such as Alzheimer's disease? To sympathize how I become about answering the question, let'south starting time by reviewing the basics of what it ways to have dementia.

5 Central Features of Dementia

A person having dementia means that all five of the following statements are true:

• A person is having difficulty with one or more types of mental function. Although it's common for memory to be affected, other parts of thinking function can exist impaired. The 2013 DSM-five manual lists these six types of cognitive function to consider: learning and memory, linguistic communication, executive part, complex attending, perceptual-motor function, social cognition.

• The difficulties are a reject from the person'south prior level of ability. These tin can't be lifelong problems with reading or math or even social graces. These problems should correspond a alter, compared to the person's usual abilities every bit an adult.

• The problems are bad enough to impair daily life office. It's not enough for a person to take an abnormal result on an office-based cognitive exam.  The problems also have to be substantial enough to affect how the person manages usual life, such as piece of work and family responsibilities.

• The problems are not due to a reversible condition, such as delirium, or some other reversible illness. Common atmospheric condition that can cause — or worsen — dementia-like symptoms include hypothyroidism, depression, and medication side-effects.

• The bug aren't better deemed for past another mental disorder, such as depression or schizophrenia.

Dementia — at present technically known as "major neurocognitive disorder" — is a syndrome, or "umbrella" term; it'southward not considered a specific disease. Rather, the term dementia refers to this collection of features, which is caused by some grade of underlying damage or deterioration of the encephalon.

Alzheimer'due south disease is the virtually common underlying crusade of dementia. Vascular dementia (damage from strokes, which can be quite pocket-size) is too common, as is having two or more underlying causes for dementia. For more on atmospheric condition that can cause dementia, see hither.

What Doctors Need to Practise To Diagnose Dementia

Now that we reviewed the v key features of dementia, permit'south talk virtually how I — or another medico — might become about checking for these.

Basically, for each feature, the dr. needs to evaluate, and certificate what she finds.

i. Difficulty with mental functions. To evaluate this, information technology'south all-time to combine an part-based cognitive test with documentation of real-world problems, as reported by the patient and by knowledgeable observers (eastward.g family, friends, assisted-living facility staff, etc.)

For cognitive testing, I generally use the Mini-Cog, or the MOCA. The MOCA provides more than information but it takes more time, and many older adults are either unwilling or unable to get through the whole test.

Completing office-based tests is important because it's a standardized way to document cognitive abilities. Just the results don't tell the doc much about what's going on in the person's actual life.

So I ever ask patients to tell me if they've noticed whatever trouble with retentivity or thinking. I as well effort to go information from family members about any of the eight behaviors that are common in Alzheimer'southward. Lastly, I brand note of whether there seem to be any bug managing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

2. Decline from previous level of power. This feature tin can be hard for me to detect on my own during a unmarried visit. To document a decline in abilities, a doc can interview other people, and/or document that she's reviewed previous cognitive assessments. I have as well occasionally documented that a patient is currently unable to correctly perform a cerebral task that is related to her career or didactics history. For example, if a former auditor can no longer manage bones arithmetic, it's reasonable to assume this reflects a turn down from previous abilities.

iii. Impairment of daily life function.This is some other feature that can be tricky to detect during a single visit, unless the patient is very dumb. I usually start by finding out what kinds of ADLs and IADLs help the person is getting, and what kinds of bug accept been noted. This often means talking to at least a few people who know the patient.

Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with offset.

In some cases — usually very early on dementia — it can be quite hard to determine whether a person'southward struggles have go  enough to qualify equally "harm of daily life office." If someone isn't taking his medication, is that simply regular forgetfulness? Ambivalent feelings near the medication? Or actual impairment due to brain changes? If I'm not sure, then I may document that the situation seems to exist borderline, when information technology comes to harm of daily life office.

iv. Checking for reversible causes of cerebral impairment. I mentally dissever this step into two parts. First, I consider the possibility of delirium, a very common land of worse-than-usual mental function that's oftentimes brought on by illness.  For instance, I've noticed that older people are oftentimes mentally assessed during or later on a hospitalization. But that's not a good time to try to definitely diagnose dementia, because many elders develop delirium when they are sick, and it can take weeks or even months to render to their previous level of mental office.

(My approach to considering dementia in older adults who are confused during or after hospitalization: Brand a note that they may take underlying dementia, and programme to follow-up once the brain has had a chance to recover.)

After because delirium, I check to encounter if the patient might have another medical problem that interferes with thinking skills. Mutual medical disorders that can affect thinking include depression, thyroid problems, electrolyte imbalances, B12 deficiency, and medication side-effects. I likewise consider the possibility of substance abuse.

Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes boosted evaluation.

If I practice suspect delirium or another trouble that might cause cognitive damage, I don't dominion out dementia. That's because it's very mutual to have dementia along with another trouble that's making the thinking worse. But I practise plan to reassess the person's thinking at a later appointment.

5. Checking for other mental disorders.This pace can be a challenge. Depression is the well-nigh mutual mental health trouble that makes dementia diagnosis difficult. This is considering depression is not uncommon in older adults, and it can cause symptoms similar to those of dementia (such as apathy, and poor attending). We too know that information technology's quite common for people to take both dementia and depression at the same time.

In many cases, there may be no easy manner to determine whether an older person'southward symptoms are depression, early dementia, or both. And then sometimes we end upwards trying a course of depression treatment, and seeing how the symptoms evolve over time.

It'due south also important to consider the older person'south mental wellness history. Paranoia and delusions are quite mutual in early dementia, but could be related to a mental wellness status associated with psychosis, such as schizophrenia.

Is information technology Dementia or Balmy Cognitive Damage?

Sometimes, when an older person is having memory problems or other cognitive issues, they end up diagnosed with "mild cerebral impairment."

Mild cognitive harm (MCI) means that a person'southward retentivity or thinking abilities are worse than expected for their age (this should be confirmed through office-based cognitive testing), but are peachy plenty to impair daily life function.

The initial evaluations for MCI and dementia are basically the same: doctors demand to do a preliminary office-based cognitive evaluation, ask most ADLs and IADLs, await for potential medical and psychiatric bug that might be affecting encephalon function, check for medications that affect cognition, and so forth.

I explain more about MCI in this commodity: How to Diagnose & Treat Mild Cognitive Damage.

But remember: in practical terms, if an older person's memory problems have gotten bad enough that he can't grocery store the way he used to, or she can no longer manage her finances on her own…those qualify as impairment in daily life function. And so, a diagnosis of "mild cognitive impairment" is probably not appropriate for those cases.

Can Dementia Be Diagnosed During a Unmarried Visit?

And so tin can dementia exist diagnosed during a single visit? As you tin see from above, information technology depends on how much data is easily bachelor at that visit. It also depends on the symptoms and circumstances of the older adult being evaluated.

Memory clinics are more probable to provide a diagnosis during the visit, or soon afterward. That'southward because they commonly request a lot of relevant medical information ahead of time, send the patient for tests if needed, and interview the patient and a family fellow member (or other knowledgeable "informant") extensively during the visit.

But in the primary care setting, and in my own geriatric consultations, I observe that clinicians need more than one visit to diagnose dementia or probable dementia. That'southward because we usually demand to club tests, request past medical records for review, and gather more than information from the people who know the older person beingness evaluated. It's a fleck similar a detective's investigation!

Can Dementia exist Inappropriately Diagnosed in a Unmarried Visit?

Sadly, yes. Although information technology'due south 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. (Information technology's besides common for them to hardly document annihilation in terms of the older peron'south cognitive state, other than "confused, didn't know date.")

Now, ofttimes these doctors are correct. Dementia becomes mutual equally people age, and so if a family complains of retentiveness problems and paranoia in an 89 yr old, chances are quite high (at least lx%, according to UpToDate) that the older person has dementia.

But sometimes it's not. Sometimes information technology's slowly resolving delirium along with a encephalon-clouding medication. Sometimes it's depression.

Information technology is a major thing to diagnose someone with dementia. So although it's not possible for an boilerplate doctor to evaluate as thoroughly as the memory dispensary does, it's of import to document consideration of the five essential features of dementia that I listed above.

If You're Worried About Possible Alzheimer'south or Dementia

Let's say you're like the man I spoke to recently, and you're worried that an older parent might have dementia. (Remember, most dementia is due to Alzheimer'south or a similar underlying brain condition.) Y'all're planning to have a doctor assess your parent. Hither'south how you can help the process along:

• Obtain copies of your parent's medical data, then you tin can bring them to the dementia evaluation visit. The most useful information to bring is laboratory results and any imaging of the encephalon, such as CAT scans or MRIs. See this mail for a longer list of medical information that is very helpful to bring to a new doctor.

• Write downwards worrisome behaviors and problems, and bring this documentation to the visit. You lot tin can start with this list of viii behaviors to track if yous're concerned about Alzheimer's.

• Consider who else might know how your parent has been doing and behaving recently: other family members? Close friends? Staff at the assisted-living facility?  Inquire them to share their observations with you and jot downward what they tell you. Share these notes, along with the names of the informants, with your parent's doctor.

• Be prepared to explicate how your parent's abilities have changed from earlier.

• Be prepared to explicate how your parent is struggling to manage daily life tasks, such as piece of work, house chores, shopping, driving, or any other ADLs and IADLs.

• Bring data well-nigh any contempo hospitalizations or illnesses.

• Bring information about whatever history of depression, depressive symptoms, or other mental illness history.

By understanding what information technology takes to diagnose dementia, and by doing a little accelerate preparation when possible, yous will improve your chances of getting the evaluation you need, in a timely mode.

And if you have an aging parent who is refusing to get evaluated for memory loss or other concerning symptoms: my free online training for families (meet below) covers how to get past this, and includes a nifty PDF summarizing what to say and not say to your parent who may accept dementia.

This commodity was first published in 2015, and was concluding updated by Dr. Grand in April 2022.

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Source: https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/