Addressing Dementia Early

People may experience symptoms of dementia for 3.5 to 5.5 years before receiving a diagnosis, studies show. While the most common causes of dementia-Alzheimer's disease and vascular conditions-can not be halted or prevented, an early diagnosis creates important advantages for seniors and their families.

Many people, including some physicians, misinterpret the symptoms of dementia as normal aging. While some cognitive decline is expected as we age, impairment that causes functional disability is not normal. Often, a correct diagnosis is not made until a point of crisis, like a driving accident. In other cases, the early signs of dementia can be so subtle that they go undetected. If an older adult does experience confusion or new forgetfulness, he or she may act in denial.

"Dementia means that a person has lost abilities that he or she had before," explains Dr. Janet Lawrence, Director of the Memory Clinic at McLean Hospital in Boston. "It is usually represented by an impairment in memory plus a decreased ability to do tasks, like driving or managing money. Caregivers should watch for functional losses like these."

Process of Elimination

The earliest symptoms of dementia should prompt an initial clinical evaluation. Most primary care physicians (preferably a geriatrician) can perform this evaluation. In turn, the patient may be referred to a specialist, such as a neurologist, geriatric psychiatrist or neuropsychologist to help determine the exact diagnosis. An evaluation consists of mental and functional screening, a focused history and a physical exam. Reports from family members also are important.

Making a diagnosis can be complicated in that symptoms may be associated with both dementia and other conditions, mostly commonly depression. Simply stated, an evaluation for dementia is a process of elimination in which each possible cause is looked at in turn. The first determination is whether a person is experiencing age-related cognitive decline. If the symptoms are not attributable to normal aging, the next step is to rule out other possible causes, like drug interactions, alcohol use, medications that cause confusion and medical conditions like thyroid problems, vitamin deficiencies or depression. Minus another reason for the symptoms, the task it to determine what kind of dementia is present.

The Earlier, The Better

An early diagnosis of dementia gives individuals and their families time to cope, as well as to make necessary financial and legal arrangements while the person is still able to offer input. It also increases the opportunity for treatment. While Alzheimer's disease is irreversible, drug therapies may stabilize a person at the current level of functioning for a period of time. Dr. Lawrence explains, "The earlier you start people with the cholinesterase inhibitor drugs, the more potential benefit there is."

In addition, an accurate diagnosis prevents inappropriate treatment that can result from a misdiagnosis. For example, people with early dementia often appear depressed because they are not participating in activities they once knew how to enjoy. Their passivity makes them appear withdrawn and depressed when, in actuality, they are suffering an effect of dementia. Diagnosing the root problem allows the person to be treated first for dementia and, possibly, comorbid depression.

Allaying Fears

Seniors experiencing memory difficulty or functional loss may feel vulnerable. They may resist an evaluation of their mental state for fear of being found deficient or demented. Dr. Kevin Domingos, a neuropsychologist at the Hebrew Rehabilitation Center for the Aged in Boston, stresses the importance of consulting a geriatric specialist. Physicians that understand the problems and fears of older persons typically will spend time addressing concerns and building rapport.

"I try to impress upon them that we're not here to pick on them or examine their faults," Dr. Domingos says. "We're here to look at their strengths and weaknesses-because everyone has them-and we'll work on the weaknesses to enhance their quality of life."

Until there is a solution for the prevention or more effective treatment of dementia, our goal can only be to improve the quality of life of those affected by it, including individuals and families. An early diagnosis creates the best chance of doing so.

About MINES & Associates

For over 25 years MINES & Associates has been a nationally recognized business psychology firm that provides a variety of services to corporate employers including employee assistance programs (EAP), managed mental healthcare, organizational development and psychology services, wellness programs, behavioral risk management, disease management, PPO services, and a number of other technology based services. MINES & Associates is divided into two main divisions, Organizational Psychology and Health Psychology, and currently serves a diverse portfolio of clients in all 50 states, Canada, Mexico, and the UK.

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