Dementia Diagnosis: Doctors and Questions

When you or a loved one is concerned about the possibility of having a dementia, getting a thorough evaluation is the next step. Knowing and understanding what is happening will help you with interventions and planning.

So, what should you do? Here is a brief list of considerations and steps to take:

Select a physician.

  • Consider the physician’s knowledge and comfort regarding working with older adults.
  • Consider making an appointment with a geriatrician, a physician who is specially trained to diagnose and treat older adults. Don’t necessarily avoid other doctors, including family practitioners and internists, though; they often have the same knowledge and skills.
  • Understand that additional specialists may be included in the diagnostic and treatment process. They may include neurologists, psychiatrists, psychologists, and other specialists as needed.

Schedule a doctor’s appointment, which will include several types of examinations.

  • Physical exam, including
    • medical history
    • family medical history
    • physical exam
    • laboratory tests of blood and urine, particularly to rule out other possible causes of symptoms
    • review of prescribed medications, patient-opted medications, and supplements
  • Social and behavioral profile, particularly a log of recent changes and concerns as seen by the patient and/or others
  • Neurological exam
    • assessment of balance, reaction time, reflexes, coordination, muscle tone, speech, sensation, etc.
    • ruling out of conditions and diseases, such tumors and strokes
  • Mental status test that evaluates awareness, memory, problem solving, executive function
  • Psychological evaluation, often to rule out other causes of dementia symptoms, such as depression, anxiety, other mental illness concerns/illnesses
  • Brain scans (not routinely administered)

Ask the doctor questions to be sure you understand the diagnosis.

  • Diagnosis by name
  • Evidence that underlies the diagnosis: What did the doctor see in exams and tests that led to the diagnosis?
  • Doctor’s assessment of the current stage of the disease
  • Possible interventions, including therapies and medications
  • The role of the doctor going forward

Would you like help navigating the diagnosis process? Contact Dr. Cheryl Greenberg at TheAgeCoach@gmail.com to discuss your concerns and plan the next steps in getting and understanding a diagnosis.

Cold Weather & Dementia

It is winter . . . really winter. . . with temperatures in the teens and 20s, heavy gloves, warm soup, and a genuine reluctance to be outside if we are not skating or skiing. Still, most of us know how to navigate and even enjoy a crisp cold day.

But what about a person who has a dementia? Do you know the dangers of cold weather for older adults and individuals with dementia?

During cold weather, you may find folks

Living in cold homes without realizing the danger of being cold

Venturing outside without warm clothing or protection from wet weather

Experiencing low body temperatures as a result of taking medications or drinking alcohol

Falling on ice and becoming disoriented in snow falls

The overall concern is hypothermia, which is a condition in which the body temperature is dangerously low. Hypothermia can cause confusion, disorientation, problems with communication and behavior, and physical impairment. Hypothermia may lead to death.

Caregivers can help by being sure that older adults and individuals with dementia stay in warm environments, eat well to ensure healthy body “insulation,” and avoid activities that might lead to hypothermia.

We can also help individuals with a dementia enjoy lovely winter days. As always, care giving involves sharing positive experiences with an extra layer of safety. For our cold crisp days, let’s help our loved ones with cozy wool scarves, bowls of warm soups . . . and hand-in-hand ventures to see beautiful snow falls.

 

For a brief overview of ways to avoid and treat hypothermia, see the Alzheimer’s & Dementia Weekly article, Hypothermia.

 

Celebrating Holidays When a Loved One Has a Dementia

The winter holidays are here! Thanksgiving with turkey and the trimmings, conversation, football on TV, and family games. Kwanza, Christmas and Chanukah are next. What warm memories of these celebrations many of us have and how much we would like to participate in all our usual traditions.

But . . .

We are caring for a loved one who has a dementia. Everyone is adjusting to new ways of living our daily lives. We don’t have energy for all our usual preparations. And some of the old traditions aren’t appropriate for a person who has a dementia.

How can we have our special holidays? Here are a few quick tips.

  • Adjust your celebrations.
    • Modify and simplify your traditions, keeping some of the special memories.
    • Involve your loved one in holiday activities that are comfortable and safe for him or her.
  • Communicate with family and friends.
    • Talk about your loved one’s strengths and changes.
    • Plan new traditions together.
  • Take care of yourself.
    • Ask for help with holiday tasks and caring for your loved one.
    • Arrange for respite time . . . quiet time, pampering, exercise . . . for you.

Holidays can still be special for you, your family and friends.

Enjoy the possible. Enjoy the moment. Enjoy new traditions.

For more about holiday celebrations, read the National Institute on Aging article, “Holiday Hints for Alzheimer’s Caregivers” at https://www.nia.nih.gov/health/holiday-hints-alzheimers-caregivers.

 

 

 

Mother’s Day for Mom and Her Caregiver

Celebrating in new ways:

As we approach Mother’s Day, many of us think about how different the celebration is, now, if Mom is in the middle or late stage of Alzheimer’s Disease or another dementia. We feel sadness, but we also try to honor our mothers in ways that they will understand.

Tips abound on the Internet and in publications, and the tips are wise:

  • Simplify the celebrations.
  • Adapt your expectations about what Mom will understand and enjoy.
  • Give gifts that are meaningful today: soft items to hold, fragrant flowers, a bird feeder that Mom can watch from the living room or porch.
  • Listen to Mom’s stories about the past, if she can tell them, and tell the stories to Mom if that meets her needs better.

Still, there are important statistics that suggest there is more to do.

The majority of caregivers for older adults. . . about 2 out of 3 . . . are women; about a third of the caregivers are daughters of the older adult.

As we know, caregiving is time consuming and stressful. It causes the caregiver to put aside her needs, relaxation, hobbies and interests. While the caregiver is providing love and support, she may not have time to “receive” love and support in return.

So, on Mother’s Day this year, let’s celebrate with Mom, but let’s also celebrate the caring and generous hearts of the daughters and daughters-in-law who are by Mom’s side.

  • Provide respite for caregivers . . . time away from responsibilities.
  • Give gifts that show appreciation and provide the pampering that relieves stress: a gift certificate for a massage, tickets to an art exhibit or popular movie, a quiet meal on the patio.
  • Listen to the caregiver’s stories. She may well need to share the delights and the stresses of her caregiving days.

 

For ideas about celebrating Mother’s Day, read an article posted by the New York City Chapter of the Alzheimer’s Association at Honoring  Mother’s Day When Mom Has Alzheimer’s.

For “2018 Alzheimer’s Facts and Figures” (and caregiving statistics), go to https://www.alz.org/facts/.

 

Caregiving: Can You Make Medical Decisions?

Who Can Make Medical Decisions in a World with HIPPA?

American’s medical records are protected by the Health Information Portability and Accountability Act (HIPAA). Neither friends nor relatives have access to our medical information without the express consent of the patient.

This is usually comforting in a world with so much data and so much communication!

But what happens when a senior needs help with his or her medical decisions? What happens if there are end of life decisions to be made?

Three legal documents give others insight and permissions on behalf of a senior.

  • HIPAA authorization gives permission to the doctor to share medical information with the person(s) that the patient names.
  • An advance health care directive (living will) lists/describes an individual’s preferences about medical care, including whether certain life-sustaining treatments should be administered.
  • A medical power of attorney (health care proxy, durable power of attorney for health care) identifies someone who can act on behalf of the individual if needed.

It is not always comfortable to think about illness and end of life decisions. However, there are many resources available that can help. Attorneys are skilled at advising and preparing the documents. Information and forms are available in print and on the Internet, as well.

For a brief description of medical powers of attorney and living wills, look at WebMD.com’s Advance Directives.

 

Is This Dementia? Memory Changes

He isn’t remembering well. Does He Have a Dementia?

How often has a loved one forgotten something and, for a split second, you said to yourself, “Why didn’t he remember that? What does this mean? Should I be concerned?” Here are guidelines to help you.

The car keys are missing. Is he losing his memory?!

  • We all put our house keys down and forget where we put them.
  • We forget a name even though we know the person.
  • We go to the supermarket for eggs and come home with coffee, bread . . . but no eggs.

Are these signs of dementia?

Everyone forgets from time to time. As we get older, we forget more often.

However, it is not a sign of dementia if we can remember the keys, name and eggs after a little while and our forgetting doesn’t stop us from carrying out our normal activities.

Some forgetting is normal. Taking a little longer to remember as we get older is also normal.

Memory changes that interfere with independent activities – our work, social life, conversations, reading and learning – may indicate a health problem that should be checked by a doctor.

These memory changes may include

  • Not being able to find the right words to express something, not following a conversation, or having difficult completing a thought
  • Forgetting names of people and places
  • Being confused about where one is, not knowing how to get to a familiar location, or not being able to retrace one’s steps
  • Having difficulty recalling the information needed to make appropriate judgements and decisions
  • Not recalling where an item has been placed even with time and effort

HelpGuide.org offers a quick look at how to figure out what forgetting the car keys might indicate at What Does My Forgetting Mean?

Is This Dementia? Activities of Daily Living

Does she have a dementia?

Every day, we all take part in activities that we do routinely, often without much thought or planning. We complete work tasks, take part in hobbies and social events, cook and clean, and care for ourselves.

When an individual is not able to independently and reliability complete “activities of daily living” (ADLs) he or she may be showing signs of Alzheimer’s Disease or another dementia (cognitive impairment).

Having temporary trouble with an activity of daily living may not be alarming, but when an individual has persistent difficulties with one or more ADL, it is recommended that they consult with a physician for a thorough examination.

What are “Activities of Daily Living”?

Activities of Daily Living (ADLs) are tasks that we carry out routinely every day. They include

  • Eating
  • Hygiene: bathing, washing, brushing teeth, and grooming)
  • Dressing: selecting and putting on clothing
  • Using the toilet and maintaining continence
  • Movement: walking and getting into and out of bed and chairs

There are also Instrumental Activities of Daily Living (IADLs), which are more complex tasks that have an impact on whether an individual can function independently. For example,

  • Communication: using phone, email or other tools to communicate as needed
  • Transportation: driving or using appropriate public/private transportation
  • Shopping: buying food, clothing, medications, and other necessities
  • Food preparation: making appropriate food choices, preparing and storing foods safely, and following recipes
  • Medications: organizing and taking medications appropriately
  • Home maintenance: completing tasks related to safety, cleanliness, and proper functioning of the home and appliances
  • Finances: making sound financial decisions, keeping accurate financial records, and understanding one’s financial resources

 

The American Elder Care Research Organization provides its definitions of ADLs and IADLs, along with a checklist for informal use, at ADLs & IADLs.

Another article, by social worker Esther Heerema for VeryWell.com, provides information about the reasons for changes in ADLs and some tips for caregivers at ADLs – Causes and Tips.