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Evaluating Dementia

October 8, 2016

Dementia is not a disease, it is a brain impairment impacting daily life – but what IS that cognitive impairment? What is the cause of the dementia?

As noted earlier, approximately 70% of dementias are Alzheimer’s related – but that means 30% are something different. Very often it is a vascular dementia, resulting from problems with the vascular system.

This type (along with the rare frontotemporal dementia) presents very differently, not with short-term memory loss but with symptoms of frontal lobe damage – verbal confusion, poor impulse control, and decreased executive functioning. This may come to the family’s attention when the person shows uncharacteristically poor judgment, giving away money or falling for scams.

Other dementias also impact behavior dramatically. They may have some Alzheimer’s-type features, but also can create psychosis, paranoia, delusions. This is why it is critical, in terms of care planning and treatment options, to understand the type of dementia, because each type has a different trajectory.

At certain stages, Alzheimer’s disease can be indicated with a short screening for basic memory problems, attention span, ability to do simple arithmetic, etc. In non-Alzheimer’s cases, often families suspect there is a problem, but their loved one, with an engaging, social personality, can go to the doctor and present very well in a 15 minute medical appointment. Her language is good, she is oriented to time and place, even her memory is good… but those closest to her know she’s not the same.

When the family knows something is wrong, that a person is making poor choices, those dementias get more complicated to diagnose, and sometimes require evaluation by a neuropsych or neurologist. Bloodwork and a CT scan are critically important for this more complex diagnosis.

Care managers can do cognitive screening to look for deficits, using comprehensive screenings that involve talking with family members, charting the history of who the person is now vs. who they were, and noting what changes have been seen. This basic screening can indicate more testing is needed, or can give the family a baseline to compare and look for changes from year to year.

Especially challenging for families is the senior who has had an underlying, often undiagnosed, mental health problem, and is additionally now having dementia issues. This can result in increased behavioral disturbances and paranoia, and makes finding the most appropriate care critical.

Most care managers are experienced in working with these very complex situations, and should be able to help find the best home care providers, or the most appropriate facilities for those with behavioral disturbances. The last thing a dementia patient needs is to be moved from place to place because they aren’t getting what they need; or worse still, being removed from a facility that is unable to manage their unique needs.

In addition to the basic planning for future care, if you are a dementia patient it is important to begin planning along the trajectory of the disease. This is why understanding the type of dementia is critical, since each is different. Long before the dementia takes full hold, it is important to work with a professional team, including not only doctors and care managers, but the family lawyer and CPA.

Care Management Group of New Mexico has Springing Care available that works with you to make choices now when you may not be able to in the future. By identifying everything from your core values (such as end of life plans and religious preferences) through life comforts (how/where do you want to live, what foods/music do you like), your wishes and desires can be documented and preserved for the time when you are no longer able to make decisions. Contact us to learn more.