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Topic Dementia Go to previous topic Go to next topic Go to higher level

By jburkhart On 2010.04.22 13:26
I believe that my husband is now dealing with dementia. I often feel like I am dealing with a child. When i had mentioned this to his neurologist a year ago he just put him on a med and did not do any testing. (he didn't do well on that med). any way he is much worse now. What I am wondering is about testing for dementia. Are there good tests. What can I ask the Dr to do. I want to know what we are dealing with and not just a prescription. Any suggestions.

By LOHENGR1N On 2010.04.22 14:05
jburthart, I posted this before but it's no trouble to post again for those newer to the forum I hope it answers some questions and gives some information to help understand these puzzling conditions. I cut and pasted from http://www.hopkinsmedicine.org/gec/series/dementia.html

Dementia is a progressive decline in memory and at least one other cognitive area in an alert person. These cognitive areas include attention, orientation, judgment, abstract thinking and personality. Dementia is rare in under 50 years of age and the incidence increases with age; 8% in >65 and 30% in >85 years of age.

Dementia results from brain damage. The causes include the following; Alzheimer’s Disease, Stroke, Pick’s disease, Huntington’s, Downs Syndrome, Creutzfeldt-Jacob, AIDS, alcoholism, Parkinson’s disease and other neurodegenerations.

Diagnosis
There are three purposes why diagnosing dementia is essential.

By determining the probable cause, treatable disorders can be identified, such as medication toxicity (benzos, H2 blockers and anticholinergics), and thyroid disease.
There are symptoms and comorbidities that are treatable, such as depression, delirium (see below), delusions, hallucinations, and agitation.
Caregivers must be identified and environmental issues taken into consideration.

A diagnosis of dementia is based on:
memory loss - both in short and long-term, plus one or more of the following:

aphasia – language problems
apraxia – organizational problems
agnosia – unable to recognize objects or tell their purpose
disturbed executive function – personality and inhibition

Dementia vs Delirium
In order to make a diagnosis of dementia, delirium must be ruled out. However, patients with dementia are at increased risk of delirium and may have both. Delirium is an acute disorder of attention and global cognition (memory and perception) and is treatable. The diagnosis is missed in more than 50% of cases. The risk factors for delirium include age, pre-existing brain disease, and medications. There are many causes, the most common are:

D Dementia
E Electrolyte disorders
L Lung, liver, heart, kidney, brain
I Infection
R Rx Drugs
I Injury, Pain, Stress
U Unfamiliar enviroment
M Metobolic

Prevention of delirium includes the avoidance of psychoactive drugs, quiet environment, daytime activity, dark and quiet at night, visual and hearing assistive devices, orientation devices, and avoidance of restraints.

Diagnosis of delirium is based on clinical observation; no diagnostic tests are available. The essestial features of delirium include:

Acute onset (hours/days) and a fluctuating course
Inattention or distraction
Disorganized thinking or a altered level of consciousness
Treatment of delirium, like dementia, is managed both pharmacologically and non-pharmacologically.

By shirley On 2010.04.22 14:14
My husband's neurologist tests him each time we go for cognitive, memory and reasoning skills. The last time we were there he said he had mild dementia, but I can see that it's getting worse. He is on exelon patch to help slow down the progression, but truthfully, I don't think it's helping that much. Some days are better than others.

The test is a fairly simple one. Counting backwards from 100 and subtracting 4 each time, remembering 5 things at the beginning and then repeating them back at the end of the test, drawing a box and following a maze with a pencil connecting numbers. I think there is one other thing, but can't remember it just now. I'll blame lack of sleep for that failure!

By Emma On 2010.04.22 18:47
Lohengrin gave you a good run down on dementia. Bless him for doing the research! Shirley is right, the neurologist can do a basic test right in his office at your regular appointment. If you want a more in-depth test you will need to go to a neuropsychologist. Our neurologist has ordered them twice over the past 8 years. The first one was interesting, I didn't see much point in the second one. My husband has also been taking Aricept for about 8 years now. I never saw any improvement with it but supposedly it does slow down the progression. At this point I don't think it's helping anymore. Oh, I think the other test that Shirley couldn't remember is spelling a word backwords.

By karolinakitty On 2010.04.22 19:35
Ditto for the tests. Mine gets one each time he goes to the neuro and has been on aricept about 4 months. Seems like so far so good. He had a rapid downward progression for a good 6-8 months but now seems to have leveled off.
Our test consists of:
the day
the date
the year
the month
what floor are we on
three words to remember later
she points to her watch , pen, shoe, whatever, usually 2 items for him to name
He draws a picture, copying one she has drawn
spells a word backwards
writes a sentence
repeats a sentence she gives

When we went to the Movement disorder clinic the testing they did was more invovled, and included motor skills. We were there several hours and it really was enlightening.

By jburkhart On 2010.04.23 10:24
thanks all. I will ask for a test at the next apt.


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