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Because I need someone who can diagnose dementia. A man asked me this question recently.

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He explained that his 86 year-old father, who lived in the Bay Area, had recently been widowed. The son wanted to know if I could make a housecall. But I get this kind of request fairly frequently. Now, note that this post is not about the comprehensive approach used in multi-disciplinary memory clinics.

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Those clinics have extra time and staff, and are deed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cognitive problems in people who are relatively young. It is adapted to real-world constraints, meaning it can be used in a primary care setting.

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A person having dementia means that all five of the following statements are true:. Rather, the term dementia refers to this collection of features, which is caused by some form of underlying damage or deterioration of the brain. Vascular dementia damage from strokes, which can be quite small is also common, as is having two or more underlying causes for dementia. For more on conditions that can cause dementia, see here.

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Difficulty with mental functions. The MOCA provides more information but it takes more time, and many seniors are either unwilling or unable to go through the whole test. Lastly, I make note of whether there seem to be any problems managing activities of daily living ADLs and instrumental activities of daily living IADLs. Decline from level of ability. This feature can be hard for me to detect on my own during a single visit.

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I have also occasionally documented that a patient is currently unable to correctly perform a cognitive task that is related to her career or education history. For instance, if a former ant can no longer manage basic arithmetic, we might assume this reflects a decline from abilities. Impairment of daily life function. This is another feature that can be tricky to detect during a single visit, unless the patient is very impaired.

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This often means talking to at least a few people who know the patient. Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first. Ambivalent feelings about the medication? Or actual impairment due to brain changes? Checking for reversible causes of cognitive impairment.

I mentally divide this step into two parts. My approach to considering dementia in seniors who are confused during or after hospitalization: Make a note that they may have underlying dementia, and plan to follow-up once the brain has had a chance to recover. After considering delirium, I check to see if the patient might have another medical problem that interferes with thinking skills.

Common medical disorders that can affect thinking include depression, thyroid problems, electrolyte imbalances, B12 deficiency, and medication side-effects.

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I also consider the possibility of substance abuse. Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes additional evaluation. Checking for other mental disorders. This step can be a challenge.

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Depression is the most common mental health problem that makes dementia diagnosis difficult. This is because depression is fairly common in seniors, and it can cause symptoms similar to those of dementia such as apathy, and poor attention. So sometimes we end up trying a course of depression treatment, and seeing how the symptoms evolve over time. Paranoia and delusions are quite common in early dementia, but could be related to a mental health condition associated with psychosis, such as schizophrenia.

So can dementia be diagnosed during a single visit? As you can see from above, it depends on how much information is easily available at that visit.

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It also depends on the symptoms and circumstances of the older adult being evaluated. Memory clinics are more likely to provide a diagnosis during the visit, or shortly afterwards.

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But in the primary care setting, and in my own geriatric consultations, I find that clinicians need more than one visit to diagnose dementia or probable dementia. Sadly, yes. Now, often these doctors are right.

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It is a major thing to diagnose someone with dementia. By understanding what it takes to diagnose dementia, and by doing a little advance preparation when possible, you will improve your chances of getting the evaluation you need, in a timely fashion. My 86 year old mom has been having erratic behavior all of a sudden — after a series of traumatic incidents, such as my dad going into hospice, her caring for him relentlessly, then being hospitalized herself with vertigo, etc. My concern over her meds as well as possible neurotoxins affect from fumigating their house this past fall ants infestation has me checking into possible external causes.

A very clear and insightful post. Also check for Urinary Tract Infection. A urinary tract infection can definitely be a cause if sudden onset confusion in an older adult, and if there are any other symptoms like a change in the frequency of going to the toilet, pain or burning with urination, or new incontinence, we would check a urine sample.

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There is so much I could write about this article. My mother is a very complex case. But what is especially interesting about her case is she has a pattern of having seemingly mental anxiety which is related to an untreated illness. She often has the mental anxiety go away when the cause of the illness goes away. This happened a few times but she also had some episodes where she was treated for mental illness likely depression and bad thoughts many years ago after pregnancy. So she had a few cognitive problems, like being bad with math since an accident as .

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Later in life she was addicted that is took nerve pills for many years, also tied to resolvable illness that was undiscovered. In getting off those drugs she took a drug that gave her a debilitating illness that stopped her ability to walk. Hardly at all. So my father and I have to wait on her and get her everything.

My dad is very old and my mom is old as well. Without going into to many details. There was known diagnostics and hidden diagnostics made by a psychiatrist. Those hidden things were kept from me by the will of my parents and covered up, or the psychiatrist put diagnosis opinions in his notes without telling my parents.

This remained hidden in her record. Now over the years my mom has seen well over 30 doctors for her physical debilitating illness and she has basically the sameher nerves are damaged and she will never walk without pain that is extreme. She has burning foot syndrome, likely caused by a side effect from a drug that destroyed not only her life but ours as we are stuck wrung for her. Two drugs she takes are Ativan and also Cymbalta. Cymbalta is being taken at 30mg dose per day.

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She also typically gets 3 hours sleep per night, and naps at times during the day. She takes heavy pain mess each day. We are talking Norco and a duregesic pain patch. The pain patch is fentanyl 50mg every three days but was 75 mg every three days before the hospital visit. She also takes lisinopril 10mg a day for blood pressure.

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The blood pressure is will rise due to pain. Level 7 normally up to level ten during a pain flare. She also has environmental chilling of her feet. She also is very demanding, but of course a part of this is due to being immobilized in a lazy boy and has a strange setup that took 3 hours to get in and out of to go to the restroom.

She has home care givers come to the house. She basically has a ton of problems and some come from adapting to the foot peoblem, a result of adapting and doing behaviors to compensate for foot pain or reduce it.

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Sitting long hours can cause more problems with your body. Chilling the room makes our family a bubble house family because the cold air le to isolation. We have had to feed her special diets and meals because her pain is related to diet as well. Salty and sweet or spices or even hot foods can cause pain flares. She lost her teeth and has to have chopped and chilled food.

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Some foods set her off. She had some minor problems she wanted to get taken care of and went into the hospital for those. She can be very demanding. If her Cymbalta is increased to 60mg a day, her requests that are always demanding with Cymbalta added go to 30 requests per minute, even a staff of four people could not keep up with those demands.

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