6. New problems with words in speaking or writing People with Alzheimer’s disease may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue, or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”). What’s typical? Sometimes having trouble finding the right word. 7. Misplacing things and losing the ability to retrace steps A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. What’s typical? Misplacing things from time to time, such as a pair of glasses or the remote control. 8. Decreased or poor judgment People with Alzheimer’s disease may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What’s typical? Making a bad decision once in a while. 9. Withdrawal from work or social activities People with Alzheimer’s disease may start to remove themselves from hobbies, social activities, work projects, or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. What’s typical? Sometimes feeling weary of work, family, and social obligations. 10. Changes in mood and personality The mood and personalities of people with Alzheimer’s disease can change. They can become confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, at work, with friends, or in places where they are out of their comfort zone. What’s typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted. Note. From Alzheimer’s Association. (2017a). 10 early signs and symptoms of Alzheimer’s. Retrieved from http://www.alz.org/10-signs-symptoms-alzheimers-dementia.asp Diagnosing dementia
Neurological examination The nervous system is tested for evidence of other neurological disorders, such as stroke, Parkinson’s disease, brain tumor, or hydrocephalus. Laboratory tests Blood and urine tests are used to check for anemia, infections, diabetes, kidney and liver disorders, nutritional deficiencies, electrolyte imbalance, oxygenation, and abnormally high or low levels of thyroid hormone. Vitamin B 12 and folate tests are ordered to rule out pernicious anemia and folate deficiency. If suspected, human immunodeficiency virus testing, drug screening, and toxin screening are performed. Serological tests might be done for syphilis. Brain imaging techniques, such as a computed tomography scan or magnetic resonance imaging, may be ordered to rule out the presence of tumors, stroke, blood clots, or other factors. An electroencephalogram is performed if a seizure disorder is suspected. Psychiatric, psychological, and other evaluations This part of the evaluation is designed to rule out the presence of other illnesses, such as depression, bipolar disorder, anxiety, and other disorders that may be causing the symptoms. The importance of a comprehensive evaluation early in the course of the disease cannot be overemphasized. After an older adult has been diagnosed with dementia, he or she may never again be reevaluated. It would be terrible to receive a diagnosis of dementia when a patient does not actually have dementia. Unfortunately, once a person is diagnosed with dementia, the diagnosis is often not questioned nor is the person reevaluated later on. The key to maintaining brain health is a healthy lifestyle. Table 7 provides tips to teach older adults how to keep their brains healthy. Research on whether exercising the brain with puzzles, games, discussion groups, and writing keeps it healthy has yielded mixed results. It does appear, however, that such activities may delay the onset of dementia even if they do nothing to prevent it (Lawtenschlager & Cox, 2013).
A diagnosis of dementia is never made based on memory loss alone. Several memory screening tools (Mini-Cog, Clock Drawing Test, and Mini-Mental State Examination) are available to be used for the Medicare annual wellness visit. Additionally, a workup should be completed by the patient’s primary care provider. The examination will attempt to rule out any physical, emotional, or psychosocial cause for the cognitive impairment and to determine whether a dementia is present and what type of dementia it is. Because there are many different causes of dementia – with many different types of treatment – an accurate diagnosis is essential. History An accurate history, including the patient’s current mental or physical conditions, medication usage, and family history of health problems, is essential in making a diagnosis of dementia. The history should be obtained from family or a caregiver if possible, without the patient present, so the informant will be free to express the patient’s deficits and behavior without embarrassment to the patient. The history of onset and symptoms is vital. This would include questions such as: What kind of symptoms have you noticed? When did the symptoms begin? How often do they occur? Have they gotten worse? Do they fluctuate? It may also include questions directed to the family about a patient’s visual cues, such as a change in hygiene, dressing, gait, motivation, and facial expression. Mental status evaluation There are many “home screening kits” being marketed to consumers. These should never take the place of a medical evaluation. Cognitive problems are far too complicated for family members or the patient to self-diagnose. The healthcare professional will select one or more of many different screening methods available to determine the patient’s cognitive level. These screenings also aid in monitoring results of treatment. Physical examination In addition to the usual physical examination components, particular attention should be paid to assessment of nutritional status.
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Book Code: PTNY3622B
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