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Dementia is a debilitating syndrome that affects millions of people around the world. It is a term characterized by memory loss and the loss of mental skills that cause problems in your daily life. Haute MD expert Dr. Deborah Houk assesses patients for dementia by looking for ongoing memory problems plus a decline in a higher cognitive function area (either language, judgment, visuospatial, or executive functioning) that are significant enough to affect daily life.
The most common cause of dementia is Alzheimer's disease, but it is important to note that there are many other causes of dementia like vascular dementia, Parkinson’s disease, frontotemporal dementia, Lewy body dementia, and severe head trauma, among others. In this article, we will explore the dementia diagnosis, symptoms, and treatment options.
How can dementia be diagnosed?
A comprehensive evaluation is needed to determine if you or someone you love has dementia and includes a medical history and physical examination, a mental status examination, lab tests, imaging studies, and sometimes, an autopsy.
History and Physical Examination
The initial approach to diagnosing dementia starts with thorough interviews of the patient, family members, and/or caregivers. Physicians often focus on determining the time course and nature of the impairments the patient is having, with questions assessing the patient’s ability to complete instrumental activities of daily living like whether the patient can manage their bills, handle business affairs, purchase groceries, prepare meals, or make a cup of coffee, as all these domains can be affected when one has dementia. Patients will also be asked whether any of their relatives were ever diagnosed with dementia or had memory problems, as some causes of dementia are hereditary. From there, doctors will conduct a complete physical examination, with a focus on the neurologic exam, to reveal findings suggestive of various causes of dementia.
Mental Status Examination
Because dementia affects a person’s memory, doctors will also do a mental status exam where they ask the patient questions to find out if the patient knows who they are, where they are, and when they are. Other common parts of the mental status exam ask patients to repeat a series of words, recall objects, count back from 100 by 7's, write a sentence, or copy a picture. The questions come from a test called the Mini-Mental State Examination, which is the most studied screening test for cognitive impairment and takes less than 15 minutes to perform.
Lab Tests
The purpose of lab tests in the evaluation of dementia is to determine if any of the mental impairments are reversible or due to an alternative medical condition, rather than dementia. The American Geriatrics Society recommends a complete blood count, complete metabolic panel, calcium levels, vitamin B12, and thyroid hormone tests when evaluating someone for dementia. Additional testing can be done when appropriate like glucose testing to ensure the level of sugar in the blood is normal, toxicology screening to look for drugs that may be contributing to issues, and lead testing to look for heavy metals in the blood.
Imaging Studies
Neuroimaging studies like CT scans, brain MRIs, SPECT, and PET scans are done in the evaluation of dementia when clinically appropriate to do so. Your physician will determine if you need additional imaging studies and the reason why. Often, if a patient is on the younger side, less than 60 years old, has focal neurologic deficits, or has an abrupt onset of symptoms with rapid cognitive decline, they will receive neuroimaging studies in their evaluation. CT scans and MRIs are very helpful in ruling out other causes of dementia - including brain tumors, normal pressure hydrocephalus, and even some infections that may cause mental decline. These tests are also the gold standard to visualize the strokes seen in vascular dementia.
Autopsy
When a patient with dementia dies, sometimes, an autopsy is done to confirm the exact diagnosis. For instance, pathology after death on autopsy would show specific findings with Alzheimer’s dementia that are different than those found in Lewy Body dementia, different than found in frontotemporal dementia, and different in other causes of dementia. Dementia is a clinical diagnosis but confirming the exact cause through autopsy can help provide closure to families and loved ones.
At what age does dementia usually begin?
In patients over the age of 65, the lifetime risk of developing dementia is about 1 in 5, or 20%. In older patients in their 70s, the prevalence of dementia is 5%.
What are the risk factors for dementia?
The greatest risk factor for dementia is age, as the risk of several dementia types like Alzheimer’s disease and vascular dementia increases significantly as you age. Other risk factors for dementia worth noting are genetics and family history of dementia, atherosclerosis, high cholesterol, smoking, alcohol use in large amounts, diabetes, and mild cognitive impairment. Many of the risk factors for dementia are modifiable though, especially cardiovascular comorbidities like atherosclerosis, high cholesterol, and diabetes, along with behavioral risk factors like smoking and alcohol use.
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What does dementia do to a person?
Dementia affects patients’ daily lives and goes through mild, moderate, and severe stages.
Mild Dementia
When first suspected and within the first 1-3 years from the onset of symptoms, patients typically report mild impairments like disorientation to the date and difficulties with naming objects. Early on, you can also see issues with managing finances, social withdrawal, challenges with recall, irritability, and mood changes.
Moderate Dementia
From there, the impairments progress to a moderate level, where patients are now more confused, they can be unsure of their location, they may have difficulties with activities of daily living like grooming and dressing, and they can sometimes get lost in familiar places. This moderate stage often comes with an appropriate increase in anxiety levels, restlessness, and depression; however, it can also be accompanied by agitation and aggression. The timeline for this moderate stage is generally anywhere between 2 and 8 years from the onset of symptoms.
Severe Dementia
After about 6-12 years from the onset of symptoms, patients can begin to experience severe impairment from dementia. At this stage, patients can be unintelligible and unable to communicate clearly or effectively, they can be incontinent, and need help with every aspect of their lives. Due to this, patients with advanced dementia often suffer from concomitant issues like constipation, weight loss, and pressure ulcers, and they may even be bed bound.
What are the warning signs of dementia?
Some of the warning signs of dementia are loss of function in an area of life. For instance, patients who report that they are no longer driving, that they are no longer managing their finances, no longer cooking, no longer shopping, no longer managing their own medications, or other losses of function could be concerning for developing dementia. The other basic activities of daily living like eating, dressing, grooming, and toileting, although affected by dementia, they are more affected with advanced dementia, much later in the clinical course of dementia.
Can dementia be slowed down or treated?
Dementia can be slowed down with medications, through support, and through practical environmental changes to increase safety for the patient, however unless the underlying cause is reversible, there is no known cure. The medicines used to treat dementia help to slow cognitive decline and help control common behaviors associated with the disease process. Namely, the medications used in the treatment of dementia help improve mental function, mood, and behavior. Support is also key to the treatment of dementia. The patient as well as their caregivers need emotional support, information, and services to assist them in living safely with dementia. Finally, approaches aimed at optimizing safety for the patient and increasing the ability of the patient to function are also of importance in the treatment of dementia. The goal of dementia care is to improve the patient’s quality of life in all domains including the body and the mind.
