Monthly Archives: June 2018

A Medical Assessment

You see your parent or loved one begin to have memory problems: they ask the same questions over and over; can’t remember where they placed something; have difficulty making decisions; forget to pay bills. After administering an informal memory or task test you believe your loved one has dementia. Now what? It is time for a doctor’s opinion. 

You don’t need to rush to see a neurologist unless you think the dementia is a result of a recent head trauma. Your primary care doctor or internist, preferably one who is familiar with the patient’s history, should be okay to start. If you are in a position to choose a doctor, try to find someone who specializes in working with older patients. When my mother moved away from her home to live closer to me, I first chose a general practitioner who was near her facility and recommended by others. As her condition worsened, I sought out a geriatric doctor.

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What to expect in a medical assessment for dementia:

  • The first step in a diagnosis is a thorough physical and medical history evaluation. The doctor wants to rule out any conditions that may be related to the onset of dementia. Vision, hearing, cardiovascular, or thyroid disorders can have a direct effect on memory.

  • The doctor may administer a test to assess memory or simply ask the patient a few questions. After working with aging patients for many years, some doctors are familiar with the responses and behaviors of those exhibiting the signs of dementia and don’t need a detailed analysis.

  • Blood work will be ordered. The American Academy of Neurology recommends the following evaluation: 

                    Complete bloodcell count

                    Electrolyte levels in the blood (potassium, sodium and chloride)

                     Blood levels of glucose, urea nitrogen and creatinine

                     Blood levels of vitamin B12

                    Liver  and thyroid function tests

                    Depression screening

                    Noncontrast computed tomography (CT) or magnetic resonance imaging                                                                                        (MRI)

  • After gathering all the information about the patient, the doctor can then do an evaluation. First, a determination is made if the dementia is reversible due to conditions such as a brain tumor, depression, vitamin deficiency, hydrocephalus, or toxic reaction to a medication. If these conditions are eliminated as a cause of dementia s/he can then assess the symptoms. Certain diseases, such as Huntington’s Disease or Lewy Body Dementia are accompanied by certain behavioral markers that the doctor can identify, So the absence of these markers points to Alzheimer’s. Even though over 60% of dementia cases end up with Alzheimer’s Disease and the doctor probably suspects this is the case, this process of elimination is crucial so the doctor can decide how to proceed to help the patient.

    In many instances a diagnosis of Alzheimer’s is often not given immediately. Instead, the doctor may give the determination of Mild Cognitive Impairment (MCI). This could be called the beginning stage of Alzheimer’s, but there are some people who do not process beyond this stage, however, for the majority, with further cognitive decline, it leads to Alzheimer’s.

     

  • Medications

    With a diagnosis of MCI the doctor may prescribe iron or other vitamins along with an antidepressant. If you have heard of supplements that may decrease the effects of dementia you need to ask the doctor his opinion. Be wary of supplements accompanied by a strong sales pitch. While gingko biloba is heavily touted, research has shown minimal positive results. Current research that shows promise include a mix of Vitamin E, vitamin C, alpha lipoic acid, coenzyme Q10, omega-3 fatty acids, curcumin and Huperzine A.

    There are two types of drugs approved by the FDA for use by Alzheimer’s patients. The first, Cholinesterase inhibitors, slow down the breakdown of acetylcholine, an important chemical linked to the formation of new memories. It is sold under the name Aricept, Exelon and Razadyne. The second, NMDA receptor antagonist, helps block the activity of the neuro-transmitter glutamate by binding it to NMDA receptors on brain cells. It is sold under the name Namende, NamendaXR and Namzaric. It should be noted that while these drugs may ease symptoms associated with Alzheimer’s disease, they may only work for a short period of time, and do not halt the disease.

    Note: Home-screening tests for Alzheimer are available, but the medical profession and the Alzheimer’s Association strongly do not approve of their use. They do not prove who does not have dementia and can cause undue psychological  anguish. There is also a test that those without dementia can request that identifies a APOE gene type that can signal a person is at risk for Alzheimer’s, but again, it is discouraged. There is the possibility that the person may not get the disease, and would spend needless time worrying instead of enjoying life.