Post by norbert1 on Jun 23, 2006 9:31:29 GMT -5
Originally written for Thayer -
You write - "I'm concerned about my mom. My brothers and sister thinks she has the onset of AD. I'm either in denial or hoping for the best. Anyway what is the intial test she would take to diagnois the disease? How should I approach her on it?"
Recognizing dementia in a family member is sometimes very difficult. When our family member is experiencing various difficulties, we at first attribute it to “just getting older”. Sometimes the difficulties amplify when there are major changes in the person’s life – such as moving to a new location or the death of a spouse – and we blame the change without realizing that a dementia may be the basic cause of the confusion.
In Alzheimers, memory problems are usually the first problem to be noticed. The specific problem is putting new memories into storage, while existing memories from earlier times are not affected. The reason is that brain damage is greatest in the hippocampus, a small portion of the brain that controls the memory storage process. In alzheimers, the disease process zeros in on the hippocampus before other parts of the brain are significantly affected. The kind of problems seen when a person cannot make new memory includes losing the car in a parking lot frequently, asking a question over and over (because they cannot remember the answer you give them), repeating conversations (cannot remember that they already told you before). All of us forget things as we get older – but we realize what we forgot when reminded. A person with Alzheimers never puts the information into memory and will not remember the event when reminded (prompted).
There are some other types of dementia that do not affect memory formation in the early stages the way Alzheimers does. One dementia has prominent problems of personality change while the memory is not affected. So you should not judge by memory alone.
Other dementia problems include;
trouble with reasoning,
making decisions
dealing with more abstract concepts like math ( paying bills, keeping the checkbook, understanding bills and bank statements), reliance on cash, carrying large amounts of cash instead of using checks.
getting lost while driving (visual-spatial function needed for processing/remembering location)
understanding procedures for activities of living ( meal planning, making out shopping lists, shopping from the list, making multi-course meals, cooking with basic ingredients – may warm up prepackaged food instead)
keeping the house clean and in good repair
To see lists of problems that a person with dementia experiences, see other posts in the information section. There are three posts dealing with the problems seen in dementia.
FAQ4 - The Ten Warning Signs of Alzheimer's
The 10 warning signs published by the Alzheimers Association is the most widely quoted list, however, it is difficult to correlate specific problems to the general categories in the list.
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7112
The following two lists contain some specific behaviors and difficulties that people with dementia commonly have with activities of daily living. Take a look and see if there are difficulties that your family member is having.
FAQ7 - Behavior Changes in Alzheimer's Three Stages
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7122
FAQ22 - The 7 Levels of Dementia
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7121
If you think your family member has several difficulties and you suspect dementia - List the different problems with a brief description of the problems (and when each problem first occured. The doctor will be interested in the length of time over which the problems developed.) Get the list to the doctor before an appointment. This is important, because family doctors are notorious for brushing off vague complaints of depression or memory weakness. You need to provide instances of other thought deficits that support the possibility of dementia. Also, it is difficult to list these problems in front of your family member, and doing so will provoke a reaction and impair the relationship you have with the person. Most doctors will be discrete about reading the list. Keep it to less than one page and keep it very factual to make sure it gets read. Deliver this list/write up to the doctor’s office and instruct the staff to place it in the patient’s chart where it will be read at the beginning of the next appointment.
Then you have to get the person to the doctor’s office - this may be easier said than done. People with classic Alzheimers are totally unaware that they have any memory deficit (lack of self awareness). They know that life is more difficult than it should be, but they blame all these difficulties on others. The person with Alzheimers is unwilling to recognize that they have a problem and will actively fight against going to the doctor about a problem that they KNOW that they do not have.
Families usually use a behind the scenes approach to get the person to the doctor. They accompany the person to a regular appointment, play up any physical ailment to get the person to make an appointment, or call the doctors office and have the office call the person with some reason why they should come in (a follow up appointment, haven’t been in for a while, need a med review, etc)
You must accompany the person and go into the exam room with the person. Use any excuse (you have a minor question to ask the doctor, etc). Too often the person will go into the appointment alone and then come out and announce that the doctor said everything is fine! – then what do you do? Also, the doctor is not allowed to talk to you unless the patient is present, or has written authorization to discuss the person’s condition. While waiting for the appointment, help the person fill out paperwork. If you do not have a POA (Power of attorney for health)get a copy of a medical information release form from the receptionist– put it at the bottom of the paperwork, and try to get the patient to sign it without making a big deal about what it is. Less than honest? – perhaps- but at this stage you must fib, make up stories, anything to get the person the help they need.
Most family doctors will not diagnose dementia – they will refer to a neurologist for a proper diagnosis. The resistant family member will usually respect the authority of the doctor and follow through with the doctor’s instructions. Skillful doctors will downplay the problem and gently explain that there is something that needs to be followed up. Subtle is better to avoid provoking a negative response.
At the office of the Neurologist, it is helpful to sit in the corner where your family member cannot see you (behind the person). The doctor is likely to ask questions like "do you do the cooking for your family?" and look to you for an indication of whether your family member is answering the question accurately. (People with alzheimers often claim to do things that they stopped doing long ago.)
The neurologist will want to know what meds the person is on, so bring a list of all meds the person is on and when taken (Or just bring all the med bottles in a big Zip-lock bag) including regularly taken OTC meds and herbal suppliments.
The very basic screening test the the MMSE (mini mental state examination) It is a thirty question that tests memory and other basic thought process. The doctor will usually run other blood tests to rule out vitamin deficiencies, metabolic imbalances, or other illness. Follow up with an MRI brain scan is common. The MRI will look for the subtle signs of Alzheimers and rule out other possible brain adnormalities (signs of stroke, tumors, etc.)
One other thing that must be mentioned, people with Alzheimers lack initiative. You can not rely on the person to follow through, to make appointments, to remember and go to appointments. You must step in and make sure that these things happen.
Writeups that describe the diagnostic process:
Common Tests to Diagnose Alzheimer's
www.alz.org/AboutAD/Diagnosis/Tests.asp
Steps to Diagnosis
www.alz.org/AboutAD/Diagnosis/GettingaDiagnosis.asp
IT MAY NOT BE DEMENTIA YET. You should also be aware that there are people that have problems only with their memory. These people are said to have Mild Cognitive Impairment. They have memory difficulties only, and not the other cognitive difficulties such as judgement and ability to pay bills, for instance. These people can function independently and with out danger to themselves if they use notes, lists, etc to compensate for their reduced memory capacity. The doctor will monitor these people and usually prescribe aricept to enhance memory and slow the memory loss. Many but not all of these people convert over to dementia over a period of years. The conversion rate is about 15% per year.
Norbert
You write - "I'm concerned about my mom. My brothers and sister thinks she has the onset of AD. I'm either in denial or hoping for the best. Anyway what is the intial test she would take to diagnois the disease? How should I approach her on it?"
Recognizing dementia in a family member is sometimes very difficult. When our family member is experiencing various difficulties, we at first attribute it to “just getting older”. Sometimes the difficulties amplify when there are major changes in the person’s life – such as moving to a new location or the death of a spouse – and we blame the change without realizing that a dementia may be the basic cause of the confusion.
In Alzheimers, memory problems are usually the first problem to be noticed. The specific problem is putting new memories into storage, while existing memories from earlier times are not affected. The reason is that brain damage is greatest in the hippocampus, a small portion of the brain that controls the memory storage process. In alzheimers, the disease process zeros in on the hippocampus before other parts of the brain are significantly affected. The kind of problems seen when a person cannot make new memory includes losing the car in a parking lot frequently, asking a question over and over (because they cannot remember the answer you give them), repeating conversations (cannot remember that they already told you before). All of us forget things as we get older – but we realize what we forgot when reminded. A person with Alzheimers never puts the information into memory and will not remember the event when reminded (prompted).
There are some other types of dementia that do not affect memory formation in the early stages the way Alzheimers does. One dementia has prominent problems of personality change while the memory is not affected. So you should not judge by memory alone.
Other dementia problems include;
trouble with reasoning,
making decisions
dealing with more abstract concepts like math ( paying bills, keeping the checkbook, understanding bills and bank statements), reliance on cash, carrying large amounts of cash instead of using checks.
getting lost while driving (visual-spatial function needed for processing/remembering location)
understanding procedures for activities of living ( meal planning, making out shopping lists, shopping from the list, making multi-course meals, cooking with basic ingredients – may warm up prepackaged food instead)
keeping the house clean and in good repair
To see lists of problems that a person with dementia experiences, see other posts in the information section. There are three posts dealing with the problems seen in dementia.
FAQ4 - The Ten Warning Signs of Alzheimer's
The 10 warning signs published by the Alzheimers Association is the most widely quoted list, however, it is difficult to correlate specific problems to the general categories in the list.
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7112
The following two lists contain some specific behaviors and difficulties that people with dementia commonly have with activities of daily living. Take a look and see if there are difficulties that your family member is having.
FAQ7 - Behavior Changes in Alzheimer's Three Stages
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7122
FAQ22 - The 7 Levels of Dementia
alzheimers.proboards32.com/index.cgi?board=ADinfo&action=display&thread=7121
If you think your family member has several difficulties and you suspect dementia - List the different problems with a brief description of the problems (and when each problem first occured. The doctor will be interested in the length of time over which the problems developed.) Get the list to the doctor before an appointment. This is important, because family doctors are notorious for brushing off vague complaints of depression or memory weakness. You need to provide instances of other thought deficits that support the possibility of dementia. Also, it is difficult to list these problems in front of your family member, and doing so will provoke a reaction and impair the relationship you have with the person. Most doctors will be discrete about reading the list. Keep it to less than one page and keep it very factual to make sure it gets read. Deliver this list/write up to the doctor’s office and instruct the staff to place it in the patient’s chart where it will be read at the beginning of the next appointment.
Then you have to get the person to the doctor’s office - this may be easier said than done. People with classic Alzheimers are totally unaware that they have any memory deficit (lack of self awareness). They know that life is more difficult than it should be, but they blame all these difficulties on others. The person with Alzheimers is unwilling to recognize that they have a problem and will actively fight against going to the doctor about a problem that they KNOW that they do not have.
Families usually use a behind the scenes approach to get the person to the doctor. They accompany the person to a regular appointment, play up any physical ailment to get the person to make an appointment, or call the doctors office and have the office call the person with some reason why they should come in (a follow up appointment, haven’t been in for a while, need a med review, etc)
You must accompany the person and go into the exam room with the person. Use any excuse (you have a minor question to ask the doctor, etc). Too often the person will go into the appointment alone and then come out and announce that the doctor said everything is fine! – then what do you do? Also, the doctor is not allowed to talk to you unless the patient is present, or has written authorization to discuss the person’s condition. While waiting for the appointment, help the person fill out paperwork. If you do not have a POA (Power of attorney for health)get a copy of a medical information release form from the receptionist– put it at the bottom of the paperwork, and try to get the patient to sign it without making a big deal about what it is. Less than honest? – perhaps- but at this stage you must fib, make up stories, anything to get the person the help they need.
Most family doctors will not diagnose dementia – they will refer to a neurologist for a proper diagnosis. The resistant family member will usually respect the authority of the doctor and follow through with the doctor’s instructions. Skillful doctors will downplay the problem and gently explain that there is something that needs to be followed up. Subtle is better to avoid provoking a negative response.
At the office of the Neurologist, it is helpful to sit in the corner where your family member cannot see you (behind the person). The doctor is likely to ask questions like "do you do the cooking for your family?" and look to you for an indication of whether your family member is answering the question accurately. (People with alzheimers often claim to do things that they stopped doing long ago.)
The neurologist will want to know what meds the person is on, so bring a list of all meds the person is on and when taken (Or just bring all the med bottles in a big Zip-lock bag) including regularly taken OTC meds and herbal suppliments.
The very basic screening test the the MMSE (mini mental state examination) It is a thirty question that tests memory and other basic thought process. The doctor will usually run other blood tests to rule out vitamin deficiencies, metabolic imbalances, or other illness. Follow up with an MRI brain scan is common. The MRI will look for the subtle signs of Alzheimers and rule out other possible brain adnormalities (signs of stroke, tumors, etc.)
One other thing that must be mentioned, people with Alzheimers lack initiative. You can not rely on the person to follow through, to make appointments, to remember and go to appointments. You must step in and make sure that these things happen.
Writeups that describe the diagnostic process:
Common Tests to Diagnose Alzheimer's
www.alz.org/AboutAD/Diagnosis/Tests.asp
Steps to Diagnosis
www.alz.org/AboutAD/Diagnosis/GettingaDiagnosis.asp
IT MAY NOT BE DEMENTIA YET. You should also be aware that there are people that have problems only with their memory. These people are said to have Mild Cognitive Impairment. They have memory difficulties only, and not the other cognitive difficulties such as judgement and ability to pay bills, for instance. These people can function independently and with out danger to themselves if they use notes, lists, etc to compensate for their reduced memory capacity. The doctor will monitor these people and usually prescribe aricept to enhance memory and slow the memory loss. Many but not all of these people convert over to dementia over a period of years. The conversion rate is about 15% per year.
Norbert
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : )