By
Kristine Dwyer, Staff Writer
Dementia itself is not a disease, but rather a set of symptoms
that accompany specific diseases. Dementia is a general term
for the loss of memory, language and recognition that is severe
enough to interfere with everyday life. Researchers believe
dementia may be caused by a combination of genetic and
environmental factors. Some diseases that cause dementia are
irreversible and include Huntington’s disease, Pick’s disease,
Parkinson’s disease, Lewy body dementia, multi-infarct dementia
and Alzheimer’s disease (AD), the most common form of dementia,
accounting for 60-70% of the diagnosed cases.
An estimated 4.5 million people in the United States have
dementia. On average, patients with AD live from 8 to 10 years
after they are diagnosed, although the disease can last up to 20
years. The disease usually begins after age 60 and the risk
increases with age. Younger people may get AD; however, it is
much less common. Ten percent (10%) of Americans age 65 and
older have AD and it affects fifty percent (50%) of Americans
age 85 and older. AD is one of the most feared mental disorders
because of its progressive and relentless attack on the brain.
Despite its prevalence, dementia may go unrecognized or be
misdiagnosed in the early stages of the disease.
According to the Alzheimer’s Association and current national
studies, there are many reasons to support the early detection
of AD. An early diagnosis is crucial because that is when the
most can be done to slow the progression of symptoms. In
addition, early treatment can have a considerable effect on
maintaining a patient’s current level of functioning. An early
and accurate diagnosis can also help to identify reversible
conditions that may mimic dementia such as depression,
medication side effects, substance abuse, vitamin deficiencies,
dehydration, bladder infections or thyroid problems. An initial
assessment can avoid the trauma of a diagnosis of dementia where
it does not exist. It also prevents unnecessary and possibly
harmful treatment resulting from misdiagnosis. Other reasons
include:
-
Identifying the cause of dementia leads to proper care and
allows patients a greater chance of benefiting from existing
treatments
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Early diagnosis can help resolve the anxiety that
accompanies noticeable, yet unexplainable changes in
behavior
-
Educating persons with dementia and their caregivers gives
them time to develop advanced care planning
-
The quality of life for both the patient with AD and the
family can be maximized.
The earlier the treatment, the better the chance of a favorable
response to treatment, the longer the delay of progressive
symptoms and the less financial cost overall. The early
identification process, currently recommended by the Chronic
Care Network for Alzheimer’s Disease, includes two key tools to
identify people who may have dementia.
Tool 1: Education and Awareness Materials which recommend
the use of triggers that signal possible dementia and include
the Ten Warning Signs of Alzheimer’s Disease.
Tool 2: Family Questionnaire which aims to collect data
from family members who are often the best historians and are
more likely to be aware of the signs and symptoms (of possible
dementia) that are not apparent to the medical staff.
The Ten Warning Signs of Alzheimer’s Disease
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Memory Loss
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Difficulty Performing Familiar Tasks
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Problems with Language
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Disorientation to Time and Place
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Poor or Decreased Judgment
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Problems with Abstract Thinking
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Misplacing Things
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Changes in Mood or Behavior
-
Changes in Personality
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Loss of Initiative/Motivation
If you recognize any warning signs in yourself or a loved one,
the Alzheimer’s Association recommends consulting a physician
for a complete assessment. Early diagnosis of Alzheimer’s
disease or other disorders causing dementia is an important step
to getting appropriate treatment, care and support services.
The Family Questionnaire is designed to help identify patients
with memory problems that might go unnoticed by clinicians. It
consists of five simple questions:
In your opinion, does your loved one have problems with any of
the following challenges and how often?
-
Repeating or asking the same thing over and over?
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Remembering appointments, family occasions, holidays?
-
Writing checks, paying bills, and balancing the checkbook?
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Deciding what groceries or clothes to buy?
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Taking medications according to instructions?
The information collected from these tools can be shared with
the patient’s primary care physician and then a determination of
need for further testing or a referral to a specialist can be
made at that time.
Testing:
There is no single diagnostic test to detect whether a person
has Alzheimer’s disease. However, diagnostic tools and criteria
have been developed in recent years to make a clinical diagnosis
of AD with an accuracy rate of 85-90%. The factors used to
complete a diagnosis include:
-
Medical History
-
Mental Status Evaluation
-
Physical Examination
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Neurological Examination
-
Neuropsychological Evaluation
-
Brain Scans
-
Laboratory Tests
The assessment of AD might begin with a memory screening test in
the primary care physician’s office and then the patient may be
referred to a neurologist, neuropsychologist, a geriatric
psychiatrist or other specialist trained in the diagnosis of AD
for further testing. Caregivers and family members are
essential to the process of diagnosing early-stage Alzheimer’s
disease. They may be able to supply valuable information and
validate or deny the patient’s own reports.
A diagnosis of Alzheimer’s disease usually falls into one of
three categories:
-
Probable Alzheimer’s— indicates a physician has ruled out
all other disorders that may be causing the dementia.
-
Possible Alzheimer’s— indicates the presence of another
disorder that could be affecting the understood progression
of Alzheimer’s. The disease process appears different than
what is normally seen; yet Alzheimer’s disease is still
considered the primary cause of dementia symptoms.
-
Definite Alzheimer’s— this diagnosis can only be made at the
time of an autopsy because it requires examination of actual
brain tissue. An autopsy can confirm the presence of senile
plaques and neurofibrillary tangles in the brain, which are
the characteristic lesions of Alzheimer’s, to diagnose the
disease with 100% accuracy.
Delay of Diagnosis:
Amazingly enough, there is a significant percentage of
caregivers who are told, upon bringing their spouse or relative
to the physician, that their decline is due to ‘normal aging.’
We now know that dementia is not a normal part of the aging
process.
It is strongly recommended that persons experiencing any
dementia-type symptoms should undergo diagnostic testing as soon
as possible. A delay in diagnosis allows for a missed
opportunity for treating the patient and also increases the
chances for other problems and demands to multiply for the
caregiver. For example, since AD affects memory, patients are at
risk of not complying with the treatments that are necessary for
problems such as diabetes, high blood pressure, mental health
disorders and infections. A health crisis can then develop,
compound the effects of dementia and lead to emergency care or
hospitalization.
Caregivers may initially hesitate to bring a loved one with
dementia to the physician. Researchers at the University of
Portland found that it takes an average of 30 months from the
time family members notice the first changes and symptoms of
dementia for the person to be diagnosed with AD. Reasons cited
by caregivers were: lack of knowledge about AD, they did not
imagine that the changing behavior was part of an illness, they
were unsure what type of doctor to see or how to describe
symptoms, they felt overwhelmed with the burden of caregiving or
they feared that the illness was truly AD. Many caregivers have
reported that prior to the diagnosis, they were nearly overcome
with anxiety as they watched their loved one deteriorate. Once
the diagnosis was made, they felt a great sense of relief and
were finally able to name the disease and move forward toward a
plan of care.
There are several other reasons that contribute to a delayed
diagnosis of AD. Early symptoms are often disregarded,
mistakenly attributed to aging or even misdiagnosed. Sometimes
people with dementia are unwilling to have their mental
abilities evaluated, are defensive, or in denial of the changes
that are occurring in their lives. Physicians may not feel
comfortable dealing with memory loss issues, may not be trained
to administer cognitive tests or are reluctant to place a
patient in an uncomfortable testing situation. Patients with
high intelligence may be able to score above average on
screening tests (despite cognitive decline) and compensate for
or even mask their symptoms during the office examination, thus
leaving the physician without sufficient evidence to provide a
diagnosis. This is the point where caregivers play an important
role and can provide the most valuable data to support the
possible diagnosis of Alzheimer’s disease...continued
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