Common Diagnostic Criteria for Dementia

Over the last two decades, we’ve grown more aware of dementia, causes, and symptoms. Yet, families’ lives are turned upside down when a well-intentioned doctor hastily diagnoses a loved one’s condition as dementia.

Before we overview 15 diagnostic criteria used by medical professionals, some caveats are in order.

Over the years, I’ve witnessed families grow distraught after leaving the primary doctor’s office upon receiving a hasty diagnosis of dementia, Alzheimer’s, or Parkinson’s. Although, primary care physicians, emergency room personnel, and even physicians assistants have medical expertise and have seen a lot depending on the number of years of service, they are unlikely to specialize in dementia diagnosis and care.

Families, who suspect dementia, are advised to seek a proper diagnosis by geriatric assessment team. Such team members work together to arrive at a more accurate diagnosis than an internist will likely give. Team members include a geriatrician or geriatric doctor who specializes in geriatric medicine–diseases of the elderly (who often have multiple illnesses simultaneously). His/Her assessment is integrated with that of a geriatric social worker, therapist, psychologist or psychiatrist, speech pathologist to determine whether or not dementia is the cause of one’s symptoms such as bouts of forgetting, slight tremors, momentary imbalances, and disorientation.

The geriatric assessment team takes a medical history, and performs a physical, neurological exam, lab tests, and a mental acuity test. Below are 15 of the criteria they use to arrive at a diagnosis.

1. Older age: At age 85, the probability of living with dementia approaches 50%.

1. Head injury: Repeated concussions that include loss of consciousness (e.g., while playing football or engaged in other risky sports and occupations), can contribute to various forms of dementia including Alzheimer’s and Parkinson’s.

1. Poor cardiovascular health will reduce blood flow and oxygen to the brain.

1. Diabetes: Alzheimer’s – is it really type III Diabetes?

1. Stroke caused by a blocked blood supply in the brain.

1. High cholesterol: Clogged arteries reduce oxygen to the brain.

1. High blood pressure increases risk for stroke.

1. Obesity and lack of exercise: Studies show that exercise contributes to better brain function and better weight management.
   

1. Lower educational level or a less actively challenged brain results in lower brain cell reserves hastening onset of dementia symptoms.

1. Sleep apnea reduces oxygen to the brain and has been linked to cognitive deficits related to Alzheimer’s.

1. Impaired vision or hearing causes one to withdraw from social situations, which contributes to dementia.

1. Stride or gait a shuffling gait or small steps may be an early marker of Alzheimer’s or Parkinson’s.

1. Infections may cause long-lasting inflammation linked to Alzheimer’s.

1. Family history – genetic history contributes to up to 5% of the incidents of dementia diagnoses.

1. Finally, just living causes dementia. If you live long enough, see item 1.

CAVEAT: These fifteen diagnostic criteria must be evaluated together. One criterion, such as item 12, could be caused by arthritis with no connection to dementia. A geriatric assessment team or geriatrician evaluates a variety of life factors that enable a proper diagnosis.

For more information, read these related articles:

Diagnosing Dementia early presents a double-edged sword.http://thecaregiversvoice.com/tips-caregivers/diagnosing-dementia-early-double-edged-sword/

TYPES of Dementia – Leading causes
http://thecaregiversvoice.com/tips-caregivers/types-of-dementia-leading-cause/

TYPES of Dementia – Rarer causes
http://thecaregiversvoice.com/tips-caregivers/types-of-dementia-rarer-causes/

Dementia Signs may come earlyhttp://www.nytimes.com/2013/07/18/health/looking-for-early-signs-of-dementia.html?emc=eta1&_r=0

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Common BP Drugs Tied to Lower Risk of Alzheimer's

People who take certain commonly used blood pressure medications have a significantly lower risk for Alzheimer's disease than those who don't, a new study suggests.

Although it remains unclear exactly how drugs such as ACE inhibitors or diuretics might protect the brain, researchers say these new findings could lead to a better understanding of Alzheimer's and new treatments to slow or delay the progression of the memory-robbing disease.

 

"We found a risk reduction by 50 percent. That tells you there must be something there," said study leader Dr. Sevil Yasar, an assistant professor of medicine in the department of geriatric medicine and gerontology at the Johns Hopkins University School of Medicine.

 

The study involved information compiled from more than 2,200 older adults between 75 and 96 years of age. They had originally enrolled in an observational study examining whether the herb ginkgo biloba could reduce the risk of Alzheimer's.

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The answer to that question was no, but the researchers were able to use the data already collected to conduct a separate analysis on the protective effect of some commonly prescribed blood pressure drugs, including diuretics, ARBs and ACE inhibitors.

 

The study, published recently in the journal Neurology, showed that regular use of these medications cut the risk of Alzheimer's dementia by at least half.

 

These drugs are used by millions of older Americans. For example, Lasix is one of the most commonly prescribed diuretics. Examples of ACE inhibitors include Lotensin, Capoten and Vasotec. Teveten and Avapro are two commonly used ARBs.

 

The researchers said diuretics, which are the first-line treatment for high blood pressure, also were linked to a 50 percent lower risk of Alzheimer's disease among participants who were already showing signs of "mild cognitive impairment" -- the slight impairment in thinking and memory that is often a precursor to Alzheimer's.

 

Exactly how these drugs reduced the risk for Alzheimer's dementia, however, is still unclear. One theory is that the protective effect is the result of lower blood pressure.
 

 

High blood pressure is a known risk factor for long-term thinking and memory problems, said Dr. Matthew McCoyd, assistant professor of neurology at Loyola University Medical Center in Chicago.

"High blood pressure increases the risk of small vessel ischemic disease, in which the small blood vessels in the brain get smaller and tighter," said McCoyd, who was not involved in the study. "This can lead to a number of problems with [thinking and memory]." A reduction in blood pressure can reduce injury to the part of the brain involved with memory, he said.

 

Still, if reductions in blood pressure were at the root of the drugs' benefit, then all blood pressure medications should have lowered patients' risks for Alzheimer's disease. But not all classes of these drugs had a protective effect, according to the research.

 

"We did not find any beneficial effect from calcium channel blockers, which was surprising and disappointing," Yasar said. Beta-blockers also were not associated with a reduced risk for Alzheimer's dementia, she said.

 

Prior studies have suggested that a specific subgroup of calcium channel blockers might still have a protective effect. "It's not a finished story," Yasar said. "There is something to it, but a larger sample size is needed for an analysis of this subgroup."

 

She also said the study was limited by the fact that the data was collected to assess the effects of ginkgo biloba. As a result, the researchers were not able to determine if the patients took their blood pressure medication as prescribed or if they had used these drugs in the past.

 

So the question remains: Do certain blood pressure medications reduce the risk for Alzheimer's dementia due to a lowering of blood pressure, or is something else going on?

 

"The inherent overall health benefit of these medications isn't as clear independent of high blood pressure," McCoyd said. "Do these drugs provide additional benefits in terms of brain health? If that's the case, patients at high risk for brain disease, particularly dementia, may benefit from repurposing these medications."

 

Blood pressure drugs are already used to treat other conditions independent of blood pressure, such as tremor and headache, McCoyd said. "With so many people affected by [thinking and memory] changes, using these drugs to prevent or delay dementia would probably have the greatest social impact."

 

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McCoyd cautioned, however, that a lot more research is needed before people with normal blood pressure would be automatically prescribed blood pressure drugs to decrease their dementia risk. Although these drugs are widely considered safe, all drugs have side effects, he said. Common side effects of blood pressure medications include dizziness, cough, rash, fatigue, nausea and headache.

More observational studies like this one -- which cannot prove a direct cause-and-effect link -- are not the answer, Yasar said.

 

"It's time to do clinical trials for these [blood pressure] drugs," she said. "We know these medications lower blood pressure, but could there be something else going on? Our hypothesis is that yes, there is something else."

 

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Signs Mom or Dad Needs Caregiving Help

Maybe you've noticed that dad's unopened mail is piling up. Or mom, once meticulous about her appearance, is wearing wrinkled clothes and not doing her hair. Perhaps there are bruises on your aging parent's arms. When you bring up the subject, you hear, "Everything is fine. There's no need to worry."

Admitting they need help would mean they can't take care of themselves anymore, and no one wants to lose their independence. "Denial is the unrealistic hope that a problem is not really happening and will go away by itself. Admitting they need help and accepting assistance is not easy for people as they age. It represents a loss of independence. Denial plays a major role – and signs get ignored," says Paul Hogan, Founder and Chairman of Home Instead Senior Care.

 

The burden often falls on the family to recognize the signs that an aging parent might need help with daily living tasks.

This doesn't necessarily mean that your loved one has to go to assisted living or a nursing home, but they may need some extra help in their home. If they're not willing to admit it, how do you know if your elderly parent needs home care?

Here are signs that may indicate your parent needs help at home:

• Spoiled food that doesn't get thrown away
• Missing important appointments
• Unexplained bruising
• Trouble getting up from a seated position
• Difficulty with walking, balance and mobility
• Uncertainty and confusion when performing once-familiar tasks
• Forgetfulness
• Unpleasant body odor
• Infrequent showering and bathing
• Strong smell of urine in the house
• Noticeable decline in grooming habits and personal care
• Dirty house, extreme clutter and dirty laundry piling up
• Stacks of unopened mail or an overflowing mailbox
• Late payment notices, bounced checks and calls from bill collectors
• Poor diet or weight loss
• Loss of interest in hobbies and activities
• Changes in mood or extreme mood swings
• Forgetting to take medications – or taking more than the prescribed dosage
• Diagnosis of dementia or early onset Alzheimer's
• Unexplained dents and scratches on a car

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Wandering Off To Work

For some individuals with Alzheimer's, the practice of going to work every day is so ingrained in them. After all, they may have done that daily for 45 years. This person may benefit from a more structured day, such as an adult activity program or being given specific tasks to do. For example, you could provide her with a few folders or files with papers in them if she worked with a lot of documents prior to the onset of dementia. You could also offer her a basket of clothes to fold if this task was part of her regular duties. Thinking about what your loved one’s routine consisted of prior to dementia can help you know what types of activities would be meaningful to her.

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Won't Bathe

There are a variety of reason why your loved one with Alzheimer's refuses to take a bath including:
modesty, privacy feels invaded, dislikes bathing aide, uncomfortable (too cold, afraid of water), feels unsafe (afraid of falling), had a prior bad experience, dementia makes him or her unaware of need to bathe or forgetful about basic hygiene

Here are a few suggestions:

• Start by asking in a friendly, nonaccusatory way, "Why not?" That will give you insights into how you can help. Fear of falling down? Water too hot or cold? A lack of awareness of his or her hygiene (could flag dementia)?
• Make sure the bathing process is comfortable, in a warm, safety-proofed bathroom that includes a shower chair and grip rails.
• Provide as much modesty and privacy as possible. It may be time to switch from showers to baths, or from baths to sponge-bathing. Allow the person to remain partially clothed (or robed) if that's more comfortable.
• Allow the person as much control over the process as possible; take care not to "baby." As much as is reasonable, let your loved one choose how to bathe.

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