• Laura Cassell

Dementia Series, Ch. 2 | More Forgetful? Common with Normal Aging? Or is it Dementia?

Updated: Aug 20, 2020

Did you know being forgetful or confused when you're older doesn't automatically mean you have dementia or even early dementia symptoms? Dementia symptoms are NOT a normal part of aging. However, dementia does affect over 5.8 million people in the U.S.(2019 statistic), but it's not normal for an aging brain. So, how can we tell what type of dementia someone has? What tests/scans are available to get an accurate understanding of a loved one's cognitive changes/issues?

According to The Mayo Clinic, Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that's affected by the damage, dementia affects people differently.

Have you been noticing changes in your mom's behaviors? Are there personality traits about her that seem really different and unlike her? Are you not the only one noticing these changes? If you have any concerns your loved one is possibly experiencing symptoms of dementia - you need to immediately schedule an appointment with a trusted aging professional, such as a Geriatrician, Neurologist or a Primary Care Physician. If it's dementia, the earlier detected the better.


What you should expect at the first doctor visit:

At your first appointment, it's important the Neurologist or another aging expert explains the different memory screening evaluations and steps needed in understanding possible cognitive issue(s). Some cognitive impairments are treatable, but dementia symptoms are not. REMEMBER: Dementia symptoms CAN'T be accurately diagnosed in just this one doctor visit. There'll need to be more appointments to get an accurate understanding. For example, multiple evaluations, blood tests and brain scans need to be performed first to find out if the memory issues are due to medication interactions, depression or possible thyroid issues. (See infographic below).


The most commonly used memory screening tool is the MMSE, the Mini-Mental State Examination. This screening should only be ONE SMALL piece of the entire cognitive evaluation. This MMSE asks the patient to repeat three words back to them, draw a clock, count backward from 100, ask what year it is and about 25 other similar questions. According to the, Cognitive Screening for dementia in primary care: A systematic review (2014), research study,"The MMSE (Mini-Mental State Examination) is the most widely utilized cognitive screening test in the world, quoted in standard guides and as per the consensus of experts in the evaluation of dementia since the early to mid 1970's."

According to Yokomizo et. al (2014), the majority of the time this assessment is brief and not even completely executed for the sake of time.

When someone has possible signs of having dementia, you'll notice them starting to lose their ability to perform daily functions, such as taking medication, paying bills and driving safely. In order to diagnose the cause of these changes, a doctor studies the patterns of the loss of skills and then determines what a person is/isn't capable of doing independently.


To find what causes negative cognitive symptoms, a doctor has to run several different tests over a period of time to find out what parts of the brain are impacted and how/why these parts are impacted.


*Remember before assuming it's Dementia (untreatable) a doctor should perform other tests to see if the memory issues and changes are due to a medication interaction, depression or thyroid issues (treatable). These other health issues often present similar symptoms as Dementia.


At every memory screening appointment, your doctor should evaluate:

  1. Whether you have impaired memory or thinking (cognitive) skills

  2. Whether you exhibit changes in personality or behaviors

  3. The degree of your memory or thinking impairment or changes

  4. How your thinking problems affect your ability to function in daily life

  5. The cause of your symptoms

  6. Note unique changes visit to visit

Unfortunately, Dementia is a terminal diagnosis - for now! So, why does our health care system spend minimal time supporting research for more effective testing option(s) for cognitive concerns related to aging? Yokomizo, et. al (2014) uncovered how the current cognitive screening tests (MMSE for example) physicians and aging professionals administer most often, are minimally effective at best.


If your doctor performed multiple different memory screening tests over a period of time and all signs point to a diagnosis of dementia, be prepared with questions and document his recommendations on your phone or a notepad during the visit. It's hard to remember all the different recommendations offered, so I suggest keeping notes. The doctor will explain what capacities are preserved and how to limit future disabilities. Your doctor should offer resources for you and your loved one with dementia to help keep you both healthy and safe with the least amount disruption in your daily routine as possible. Being a caregiver for a loved one with an untreatable cognitive syndrome is no easy task. Don't forget to take care of you!


Laura Cassell, CDP

Care Manager and Dementia Practitioner

Pearl Care Solutions & Senior Care Authority-Gulf Coast

laurav@seniorcareauthority.com



References:

Yokomizo, J., Simon, S., & De Campos Bottino, C. (2014). Cognitive screening for

dementia in primary care: A systematic review. International Psychogeriatrics,26(11),

1783-1804. doi:10.1017/S1041610214001082







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