DIAGNOSING DEMENTIA & FEELING CONFIDENT ABOUT YOUR DOCTOR'S RECOMMENDATIONS
Before we get into specific details about how we confirm and treat dementia at RSHC, it may help to have an overview of the different kinds of dementia and how it happens.
What are the Different Types of Dementia?
There are multiple causes of dementia, but there are four types composing the majority of cases. They are as follows:
When people think of 'dementia,' they are usually thinking of Alzheimer's. That's because it's the most common type of dementia and the most portrayed in media and movies. In this form, a patient's memory loss is gradual, usually spanning the course of several years. The cause is thought to be a build-up of amyloid plaque and tau tangles in the brain, which can be thought of as "brain junk" clogging up the connections between neurons and resulting in a break down of nerve communication.
Family members usually start to notice something seems "a little off." Then the patient has a slow progression of memory losses and confusion. As it advances, patients will have difficulty communicating, delirium, paranoia, anxiety, anorexia, and other concerning symptoms of mental decline. Given long enough, dementia will progress until a patient's death.
Understandably, this long process is a huge emotional and financial strain on families. Sadly, there are few resources in our community to help families who need a break. As if things are not already bad enough, the Alzheimer’s Association says,
“At this time there is no treatment to cure, delay, or stop the progression of Alzheimer’s disease.”
Due to grass-roots public lobbying, however, our government has increased the corporate incentive for finding a cure. They made Alzheimer's research a high priority and set a "cure date" by 2025.
Vascular dementia is the second most common cause of dementia. Unlike Alzheimer's, vascular dementia is caused by a series of tiny strokes. Sometimes, patients are not even aware they had a small stroke. When you look at the brain under a CT scan, however, the damage of collective mini-strokes can be seen.
As vascular dementia progresses, patient families will notice similar changes as in Alzheimer's. Rather than being a slow progression, however, vascular dementia tends to happen in "chunks." Meaning, a patient may be at behavioral baseline for weeks to years, only to wake up one morning confused. This is because it's the strokes causing the memory loss, not a slow accumulation of "brain junk" as seen in Alzheimer's. While vascular dementia cannot be cured, it is possible to adjust lifestyle and medication factors to decrease the risk of having another mini-stroke.
Lewy Body Dementia
Here we have the third most common form of dementia in America. This is another progressive dementia in which abnormal collections of protein (called Lewy Bodies) accumulate in neurons and interfere with the cognitive function of the brain. Often, patients will have problems with insomnia, hallucinations, or loss of social filters (e.g. they may become inappropriately sexual, for instance). Again, there is no cure for Lewy Body dementia.
This kind of dementia is more rare. In this condition, memory remains intact. However, the frontal lobe - the area of our personalities - starts to shrink. Sometimes, this is start early in life. Patients often start to have hallucinations; rapid and profound mood swings; inappropriate behaviors; depression and anxiety; and apathy.
There are multiple conditions that can create dementia or dementia-like states. These include Parkinson's Disease; prolonged alcoholism; prolonged drug abuse; or traumatic brain injuries.
We Were Told Our Loved One has Dementia, How can we be Sure?
Dementia is a condition RSHC can help to diagnose. In many cases, however, the patient was given the diagnosis by another provider. In an ideal situation, other causes of dementia are ruled out before dementia becomes the official diagnosis. Occasionally, families and patients are not convinced it is the correct diagnosis. Occasionally, a diagnosis is made based on assumption, rather than a diagnosis of exclusion (meaning, everything else is ruled out first).
If we are asked to make a dementia diagnostic evaluation, either as a patient's primary care physician or as a second opinion, we will consider the following options and ensure the family and patient are involved in comprehensive discussions about what testing and results mean for all. In standard cases, we evaluate the patient for the types of dementia listed above, but only after taking the following conditions into consideration:
- Parkinson's Disease.
- Normal Pressure Hydrocephalus (increased pressure in the brain, which is commonly missed if imaging and proper history taking is not performed).
- Huntington's Disease.
- Severe depression. Depression in the elderly can cause something called pseudo-dementia, which means a patient's behavior looks likes dementia (including possible auditory and visual hallucinations), but is actually caused by severe and prolonged depression.
- Side effects of drugs or other substances.
- Thyroid disorders.
- B12 deficiency.
- Vitamin D deficiency.
- Forms of encephalopathy (confusions caused by things such as elevated ammonia or uric acid levels).
- Delirium (temporary and reversible confusion if the source is found and removed).
In addition to ruling out these other disorders, we will perform various forms of in-house psychiatric testing. In some cases, we will recommend brain imaging and/or neuro-psych testing by specialized providers. The majority of this work can be done in the house, via blood work, and via conversation with the patient and his or her family.
If the diagnosis is confirmed, we will work with the entire family on the next steps of care, both for the patient and the caregivers. Our goal is to ensure patients remain at home for as long as possible, while caregivers are educated and prepared for their complex role.