Evaluation of Dementia

Working with Your Physician

What is Alzheimer's Disease?

Alzheimer's disease (AD) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. Symptoms of AD can include:

  • A gradual memory loss
  • Decline in ability to perform routine tasks
  • Disorientation to time and space
  • Impairment in judgment
  • Difficulty in learning
  • Loss of language and communication skills
  • Changes in personality including inappropriate behavior, loss of interest, and changes in mood
  • Hallucinations and delusions/ false beliefs

How does your Physician know if it is AD?

There is no single test that can diagnose AD. However, trained physicians are 80-90% accurate. Your Physician needs to do a full assessment that includes:

  • An accurate medical and psychiatric history
  • A neurological/ physical exam
  • Lab tests to rule out anemia, vitamin deficiencies, and other conditions
  • An evaluation of the person's ability to do common daily activities such as managing finances and medications
  • A mental status exam to evaluate the person's thinking and memory
  • A caregiver interview

Your Physician may also request a brain scan, psychological testing, and additional lab work if he/she needs additional information.

How can you help your Physician?

You can be prepared for the appointment by bringing a list of medications, a log of symptoms or behavior changes, and a list of questions or concerns. It is also helpful to provide an accurate history of the person's medical conditions and any previous psychiatric treatment.

What can your Physician do if the diagnosis is AD?

Although there is no cure for AD, there are ways to treat some of the symptoms of the disease. Your Physician may suggest:

  • Use of medications to treat cognitive decline and memory loss
  • Referral to appropriate activities such as exercise, recreation, and adult day care services
  • Appropriate treatment of medical conditions that may contribute to cognitive changes or decline

What can be done for behavioral problems?

At times, a person with a dementing illness may display behavior problems such as wandering, paranoia, suspiciousness, combativeness or resistance to maintaining personal hygiene. These behavioral problems can seem overwhelming to the caregiver. The Physician may suggest various strategies to assist in daily caregiving tasks such as:

  • Enrollment in the Alzheimer's Association's Safe Return Program, an identification program for memory impaired adults
  • Modifying the person's environment in order to reduce confusion caused by overstimulation such as reducing noise and glare from windows
  • Explaining a task before you do it such as saying, "I am going to help you put on your shirt."
  • Providing a predictable routine at home with structured time for meals, bathing, exercise, and bedtime.
  • Providing reassurance to the confused patient without challenging their accusations or misperceptions and by redirecting their attention

If it seems that suggested strategies aren't helpful in managing the person's behavior, the physician may want to use medications to manage symptoms of depression, restlessness, hallucinations, hostility and agitation. Be prepared to provide the physician with accurate information regarding the behavior problem such as the onset of the behavior, the frequency of the behavior, the time of day the behavior occurs, and the strategies you have tried.

How can the Physician help you plan for the future?

The Physician may suggest you start planning for health care needs now by completing an advance directive. An advance directive is a legal document that a patient signs while capable of making sound decisions. It directs how healthcare treatment decisions will be made in the event of future incapacity. There are two types of advance directives:

  • Living Will that conveys the person's desire to die a natural death and not be kept alive by artificial means.
  • Durable Power of Attorney for Health Care designates an individual who can make health care decisions on behalf of the impaired person if he or she is not able to give consent.

How can your physician support you?

Often persons with AD and their families have questions regarding the disease, legal and financial planning, community resources (i.e. home care, respite services) and available support. The physician may refer you to organizations such as:

  • Alzheimer's Association 1-800-272-3900 http://www.alz.org (National Office)
  • National Capital Area (866) 259-0042 http://www.alz-nca.org (Local Office)

The physician may also suggest that the caregiver maintain regular visits to their doctor to ensure he/she is in good physical health.

Reprinted and adapted with permission of the Los Angeles Chapter of the Alzheimer's Association, July 1999.

© 1997 - 2001 Alzheimer's Association, National Capital Area. All rights reserved.

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