The most important part of making a diagnosis is to obtain accurate information from close family members and friends who know the patient well. We need to establish that a decline in a level of functioning has occurred that cannot be explained by depression or systemic illnesses such as renal or heart failure, and that the process is progressively worsening. The baseline of each individual is unique and determines the level with which we establish if there has been a deterioration.
A urinary tract infection can cause major confusion in an elderly person and should not be labeled as dementia. Pneumonia, head trauma and medication side effects often cause memory problems too, but patients get better over time and as such they do not meet the diagnostic criteria for dementia.
Memory problems are ubiquitous and by themselves are not worrisome for the onset of dementia. We all forget our keys, may have difficulty finding our car in the parking garage, or walk into the basement and not remember why we went there. Memory problems are concerning, and a sign of dementia, when a patient forgets major events, names or things that are significant. Not showing up at a daughter's wedding, forgetting names of grandchildren or not remembering how to drive are concerning enough to warrant a dementia evaluation.
Tests can include:
- blood tests for thyroid and B12 levels
- brain imaging with CT scan or MRI
- paper-pencil tests to measure memory, learning, language, orientation and other brain functions such as drawing or abstract thinking
Medications helpful for making a person with mild dementia talk more, have more interest in interacting with family members, and show less agitation or paranoid thoughts include Aricept, Razadyne and Exelon. Aricept is the most commonly used drug in this class. It helps patients live in their own homes for a longer period of time and delay transfer to a nursing home for two years or more. Numerous studies have shown that the earlier treatment starts the more the patient benefits.
Patients who have increasing difficulty with taking care of their basic needs such as getting dressed, eating or using the bathroom can benefit from taking a drug called Namenda. Clinical trials indicate that patients with moderate to severe dementia benefit the most if they take a combination of Aricept and Namenda together.
Care of Caregivers
It is critical that caregivers of patients with dementia take care of themselves too.
Often, family members feel guilty for not spending enough time with the person with dementia, and end up giving up any free time they have to care for him or her. Unfortunately, many caregivers experience a great deal of stress, develop higher blood pressure and become depressed. They need to balance their time so they do not get burned out with taking on all the responsibilities involved. The Alzheimer's Association offers many free services for caregivers. You can get more information by visiting www.alz.org or calling 1-800-272-3900. Reading "The 36-Hour Day" is a must for every caregiver.
The Alzheimer's Disease and Memory Disorders Clinic at LifeBridge Health
Michael A. Williams, M.D., medical director of The Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health, discusses its Alzheimer's Disease and Memory Disorders Clinic.