Diagnosing Alzheimers / Dementia

Most people contact their own family doctor first. He or she will do some simple memory tests. If still concerned, the doctor might refer the patient to a neurologist, psychiatrist or psychologist for further evaluation. The family doctor will coordinated everyone's contribution to the diagnosis and treatment.

If the patient would like to find a new doctor, someone with more experience with Alzheimers than the typical family doctor, then they can contact the Alzheimer’s Association to get some names and contact information.

There is no such thing as a single "Alzheimers Memory Test" that makes the diagnosis all by itself. Alzheimers is more complicated than that. The doctors are going to look at the patient's mind, body and soul to find any conditions that could affect how the brain works. There are other things besides Alzheimers that affect our memory and thinking such as anemia, malnutrition or certain vitamin deficiencies, excess use of alcohol, medication side effects, certain infections, diabetes, kidney or liver disease, thyroid problems, and issues with the heart, lungs or blood vessels.

Here are some questions your doctor might ask at the initial appointment:

• What kind of symptoms have you noticed?
• When did they begin?
• How often do they happen?
• Have they gotten worse?

Important Note - The Alzheimer's Association says that home screening tests should not be used instead of seeing a doctor. Don't let someone who is trying to pray on your insecurities and take your money, tell you whether or not you have a mental condition! You need to see a doctor, one-on-one, who knows what he or she is doing!

Besides asking basic questions like the ones above, the doctor will also interview the patient and their spouse/family members about current and past illnessess. The doctor will ask about certain medical conditions, including Alzheimers, that might exist elsewhere in the family tree.

The doctor will do what is called "Mental Status Testing" which gives the doctor an idea of whether a person:

• Is aware of having symptoms or feels nothing is wrong at all
• Knows today's date, time and location
• Can do simple mental exercises on the "Clock Drawing Test", "Mini-Mental State Exam" or "Mini Cog" test
• Do a neurological exam which covers reflexes, coordination and balance, muscle tone and strength, eye movement, speech and sensation

A neurological exam is another part of the physical. Structural Brain Imaging such as MRI's and CT's show the shape, position and volume of brain tissue. Functional Brain Imaging shows the doctor how well brain cells in various regions are working by showing how actively the cells are using sugar and oxygen. Functional Techniques to look at the brain include Positron Emission Tomography (PET) and functional MRI's (fMRI). Many of these images are used to detect and rule out tumors, strokes, damage from severe head trauma or a buildup of fluid.

If I have any advice to give, it would be to see a doctor early. If you catch Alzheimer's early, you can fight back and delay or lessen it's severity. Do all the tests, just in case the cause of the patient's problem is something else, or co-existing with Alzheimer's.

Click on the following links for detailed information on:

Mini Mental State Exam

Mini Cog Test

Clock Drawing Test

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The Four Stages Of Dementia / Alzheimers

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Alzheimer's is divided into four stages which progress from one into the next. They are classified as Pre-Dementia, Early Dementia, Moderate Dementia and Advanced Dementia.

Pre-Dementia:

The first symptoms are sometimes mistaken for ageing or stress. Detailed neuro-psychological testing can reveal mild cognitive difficulties as early as eight years before a person is officially diagnosed with Alzheimer's.

The most noticeable early symptom is memory loss, which usually shows up as trouble remembering recently learned facts or an inability to remember new information. Subtle problems with attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships), can also be signs of the early stages. Apathy is sometimes seen at this stage and it remains throughout the next three phases. This early stage of the Alzheimer's is also called "mild cognitive impairment."

Early Dementia:

The increasing challenges of learning and memory eventually leads to a doctor's diagnosis of Alzheimer's. In a few people, difficulties with language, executive functions, perception/understanding, or movements are more prominent than their memory problems.

Alzheimer's does not affect all types of memories the same. Older memories of the person's life, facts learned, and implicit memory tend to be affected less than are newer facts or memories. Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, which eventually interfere with one's writing and speaking skills. In this stage of Alzheimer's, the affected person is slowly reduced to communicating only basic ideas.

While performing fine motor tasks (finger control) such as writing, drawing or dressing, one's movements that require planning and coordination are difficult, making sufferers appear clumsy. As the disease progresses, people can often continue to perform many tasks independently, but might need help or supervision with the more mentally demanding activities.

Moderate Dementia

During this third stage, one starts losing their ability to be independent. Conversation becomes difficult, due to an inability to remember words. Sometimes wrong words are substituted. Reading and writing skills also decline. Complex movements that require coordination are more challenging, causing the ability to normal daily living activities to be difficult. During this phase, memory problems worsen, and the person may fail to recognise close relatives.

Long-term memory becomes impaired and behavioral changes become more noticeable. Common neuro-psychiatric manifestations are wandering, sundowning, irritability and labile affect can lead to crying, outbursts of aggression and/or resistance to caregiving. About a third of patients also develop illusionary misidentifications and other delusional symptoms. Urinary incontinence can develop.

During this stage of Alzheimer's, the patient's symptoms create increasing stress for their relatives and caretakers. It's at this point most loved ones must consider moving the patient into long-term care facilities that specialize in caring for Alzheimer's patients.

Advanced Dementia

During this last stage, the patient has become completely dependent upon others for care. Speaking with simple phrases or single words eventually turns to a complete loss of speech. Despite this, patients can often understand and return emotional signals. Aggressiveness might still be present but extreme apathy and exhaustion are more common.

Patients will eventually become unable to do most simple tasks without assistance. Muscle mass shrinks and mobility deteriorates to the point where they are bedridden. The Alzheimer's patient will lose their ability to feed themselves.

Finally comes death, usually caused directly by something external such as pressure ulcers or from a cold turning into pneumonia.

My grandmother had Alzheimer's. She eventually became a "vegetable" sitting in a wheelchair. She died of pneumonia.

Please click HERE to find out how doctors diagnose Alzheimer's.

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Video Games are Good for the Brain!

My grandmother went through Alzheimers to the point of becoming a total vegetable who couldn't take care of herself or have conversations. My mother has forgotten some things and when she forgot her granddaughter's name, my dad marched her into the doctor for some help. She's on medication now and dad says there's an improvement. Good. I don't want what happened to my grandmother to happen to my mom. Of course this makes me all paranoid about what's in my future. The area between Alzheimers and being naturally scatter-witted is a gray one.

I recently read a few stories about the effect of video games on the "older" population. These articles cited a University of Illionois project, funded by the National Institute of Aging. In a nutshell, the study had 2 groups- the control group that didn't play video games and the test group that spent a month playing RISE OF NATIONS which is all about creating a civilization (set up cities, merchants, create an army and more). This game was chosen because it requires strategy from the players. The people in this little experiment were in their 60's and 70's.

The results showed a positive effect on the test group who played the game for a month. Results included increased scores on cognitive tests, increases in memory, reasoning and the ability to multi-task. The "working" memory improved.

So now I know what to get my mom for Christmas!