How is Alzheimer’s Disease and Dementia Diagnosed?

have you ever wondered why it takes so long to get to a diagnosis of Alzheimer's disease or another type of dementia well the good news is is that it should take a bit of time because dementia and Alzheimer's disease are a diagnosis of exclusion which means we've ruled out any other issue that might be reversible so it's a little bit more complicated but in today's episode I'm going to walk you through the types of tests exams and screenings that should be done by your provider to get to a diagnosis and stay tuned to the end to get your free checklist of things that need to be done from my website melissab phd.com welcome back to this getting old moving towards an age friendly world I'm Dr Melissa Bachelor and I am a nurse nurse practitioner and I wear a lot of different hats in my work including hosting this weekly podcast to bring you news and information on Aging caring for someone living with Alzheimer's disease and a wide range of topics that I hope will help move us towards becoming an age- friendly world because when things are age friendly they are friendly for everyone so if you like the podcast the best way to help me grow and support the podcast is to like it share it and leave a review in whatever platform you've tuned in on today because no matter how old you are today we are all aging and these issues are going to become increasingly important if you're a millennial there are things that need to be in place when you reach the age of 65 so we have about 20 to 25 years to get these things in place to help you age with the support and choices that will help you just like the people that are 65 today your likes shares and reviews help get the information out to help more people dealing with these issues but right now let's get going on this week's [Music] episode welcome to this is getting old moving towards an agef friendly world I'm Dr Melissa Bachelor and I am a nurse nurse practitioner with over 25 years of experience working with older adults and their families be sure to subscribe to the podcast be sure to like it share it and leave a comment or a review on whatever platform you're listening to and if you're on YouTube you can actually now become a member to support the podcast and can get early access to each of my episodes each week and you can also join my community on Facebook it's called this is getting old moving towards an age-friendly world but that's a place where we can connect and you can give me feedback and suggestions for upcoming episodes but now let's talk about how Alzheimer's disease is diagnosed so what we need to do in the beginning is investigate any possible calls um and early diagnosis is really important because right now there is no cure but there may be an underlying cause that's either treatable or reversible like maybe it's your thyroid or your anemic or and and but when you're also diagnosed um early it gives you time to make lifestyle modifications that actually could help manage the disease secondly it helps to explain why you're having a harder time with your memory or decision-making and thirdly it lets you make decisions about your future and communicate your desires um to your your family and friends and unfortunately there isn't like a single test that can tell you if you have Alzheimer's disease or a related Dementia or a blend of both U which is called mixed um dementias any type of dementia is a diagnosis of exclusion so we have to do a lot of different tests to make sure there's not something else that um is causing the problem with your membrane so the six categories are we're going to do a history a physical exam we're going to do a medication reconciliation we're going to do cognitive screen ings blood work um and then a brain scan so let's break this down so for your history the first part of this is your social history and so this has a lot to do with your lifestyle factors and so these are actually modifiable risk factors but have you ever smoked do you smoke now how much alcohol um do you typically drink how much exercise um do you get each day you how much sleep are you getting um and that's pretty much what a comprehensive um social history um is going to ask also like have you had any recent deaths in the family um do you feel isolated from other people um how are you kind of functioning socially and all of those things can give a provider an indication of some other things that might be going on with you besides just um physically when you're in the office the second part of a history is your family history so do you have a family history of heart disease or diabetes or Alzheimer's disease um because your family history uh while your lifestyle factors and your social history is a bigger impact knowing your family history is important so the provider should ask about that um the next part of a history is your medical history so what chronic diseases do you have do you have a history of high blood pressure diabetes have you had cancer um and then what were the treatments for each of those things and how well controlled are they the next part is your surgical history because a lot of times with with older adults you can end up having what's called um a delirium that's B basically something that happens because you went under general anesthesia and the way that you would know it was more of a delirium is that it you were fine yesterday you had the surgery now you're not um so that's usually an indication of delirium and in geriatrics we have the 3DS which are depression dementia and delirium so we need to make sure that you're not experiencing a delirium but typically if you're in there to see like your primary care provider it's been a while but if but delirium can last up to 6 month so it is something um that it is part of your history that we need to know about so kind of like when was the last time your memory was fine is another important question and then lastly doing a review of systems and so this is where they should go through and ask you questions kind of think about from your head to your toe you are you having any trouble with your vision how is your hearing when was your last eye exam when was your last hearing exam when was the last time you went to the dentist are you having any pain so it just kind of goes on and on um short breath how are you sleeping but they should ask you um either it might be a paper that you fill out before your visit but there should be some review of kind of all of your um your systems heart brain gut um muscular skeletal everything the next part is your physical exam so this starts with Vital sign so you need to know what your blood pressure your pulse um what your pulse oximeter oximetry level is um so knowing what your vital signs are and they may even do like a finger stick just to find out what your blood sugar is doing if you have been tracking any of those things at home you need to be sure that you are bringing those in to your provider and then your provider should do a head-to toe exam and this includes looking in your ears to make sure that you don't have a wax um impactant because ear wax can actually make it really hard to hear um and that's easily removed in the office or they can give you something to take home to clear that up um if you you have heuring AIDS are you wearing them how well do they work um and then doing visual tests because sometimes if you are having um like sensory changes with hearing and vision they can mimic a memory problem and it's just because the person can't see you or hear you or if someone has had those issues and they have not been treated um that can actually lead to memory problems so making sure that there's a full um head to toe exam that's done the next part is called a medication conciliation as well as de deprescribing and so what we want here is that you need to bring in every prescription medication every over-the-counter medication that you're taking every vitamin supplement anything that you are taking you need to put it in a bag and bring it to your provider um because they they should make a comprehensive list of every medication supplement or over the- counter medication you're taking um and why you're taking those things and then looking to see if any of them them could be um deprescribed or stopped and if any of them are contributing to your memory problem um I just did an episode recently about seven medications to avoid but even something as simple as taking like a Tylenol PM or um a benad dril can increase your risk for Falls and it can impact your memory as well as other prescription medications so you can have your provider go through these to see if there are any drug to drug interactions drug to supplement interactions and then um making decisions about if any of them are unnecessary or if one of them might be a culprit for your your memory problem the next um set of screenings that need to happen are your cognitive screenings so again they should be screening you for depression and this could be again a paper that you fill out um at the very least they should ask ask you if you have been feeling sad or blue um for the past two weeks or longer because depression can actually look like a dementia and I remember I had a lady come in one time and her clock drawing was terrible we did all of these um all the screenings and testing I'm talking to you about now and at the end of the day her problems really began a couple of months after she lost her husband and so I was telling her daughter I really think what we need to do is try to treat this depression first and then bring her back and within six weeks of being on an anti-depressant her clock drawing was fine and her memory was fine so you do want to make sure that you're getting an accurate diagnosis and someone's not just making an assumption that because you're older that you have Dementia or some type of Alzheimer so making sure they're screening you for depression and then the screenings for memory issues are actually based on um six different parts the first is orientation so that is do you know what the day the date the day of the week what month um do you know where you are you know like what doctor's office what city so how oriented you oriented are you to those things the second part is language and so this has to do with verbal fluency and naming so if I ask you to write down you know as many words as you can think of but start with the letter F in one minute you know how many of those words are you able to write down as well as looking at a picture and being able to name um name what that picture is some of the like the mant cognitive assessment um is one of those exams where um sometimes educational level and life experience can matter like one of the images you have to pick out is like a camel but you know my grandmother had a fourth grade education I don't know that she'd ever seen a camel before um so sometimes you have to do the this is why these are called screenings and questions need to be asked because they can give you a different set of animals or whatever it is to recognize um like do you know what this is well it's a watch most people can get that because most people have seen watches so U the third part of it are is reason and computation so this um you may have noticed your loved one or maybe you are having more trouble dealing with numbers um so how well are you able to do math and not necessarily just in your head but in the way you've always done calculations can you subtract 100 - 7 is what 93 what is 93 minus 7 and you'll go through a series of where you're having to to do that calculation and the other part of is is abstraction so my family and I um play connections I think it's a great um brain game in addition to Wordle um because you are having to look for the um the abstract connections to those words it's a Wall Street Journal um free game that you can play um but that's the type of thing or if I gave you like a metaphor could you tell me what it means like for example example of Rolling Stone gathers no Moss like what does that mean the next part is visual spatial ability and that's a really kind of fancy word that just means can you look at a 3D image so the image of like a cube 3d can you look at that image and recreate it or could you um the other part of it is like a clock drawing test can you put the numbers on the face of the clock and then put the hands facing the hands in the direction of what ever time you're told to do that you know as we move forward um in in today's society and people use digital watches I'm not sure how good you know that's going to be um as a test um because you could tell someone you know write down 31 they might just write a three and a 10 um but you're supposed to be able to what we're doing is looking at your ability to plan and write down like is the 12 at the top the three and you on this side the six on the bottom bottom and then your nine and then fill in all the other numbers or do you kind of get do you put all 12 numbers in just the first quarter of that clock um if they do it that way it's a sign of a visual spatial issue the next part is executive function so this is problem solving um if I were to give you you know a problem and ask you what would how would you solve that problem um that would be important or even ask you an order of kind of how you would do things so that tests executive function and then memory um typically has to do with like registration and recall so if I were to tell you three words can you repeat those three words back to me and then I would go on with asking you other questions and then I would Circle back and say what were the three words that I asked you um about and if you can't remember what those three words are that's like a recall issue um meaning like you can hold information for for a short period of time um but maybe not for longer than that so three of the most common um exams that are done like in a office setting would be a mini Cog a mini mental state exam or an mmse or the Montreal cognitive assessment or the mocha um I did find one um this week that is available online it's called the self-administered jocogov exam and you can just Google that word but I also I'm going to put a link in the description below and on my website melissab phd.com for this episode um so you can click on that link and there's an online version or there's four other versions that you can download and take um the test and they say it doesn't matter which version of it you ask which version of it you take you know the important thing is just taking that so that you have a general idea if you were to self- administer an exam like this or at home if you want to administer to it administer that to a loved one um it is a a free online resource it's called the self-administered Joc cognitive exam but you'll notice that it goes right through orientation language reason visual spatial ability executive function and memory because all of them have that in common the next part of getting to a diagnosis um is blood work and again this needs to be a comprehensive panel from like a complete blood count to look for anemia or um an infection anything you underlying that a basic metabolic panel to look at your electrolytes your kidney function they need to be checking your thyroid your B12 your folate because again deficiencies um or irregularities with those tests again point to a problem that's not really an Alzheimer's issue it's another chronic condition that we need to treat and manage and so your provider should do like a full workout based on you and kind of your history and they will make those decisions um to make sure that they're checking all of your your lab values as well and then the last part are some brain scans and the options here you can get a head C or an MRI what these are looking for is actually your brain structure what those um exams or what those um tests can do is they can tell us if your brain has been shrinking it can which is more indicative of like an Alzheimer's type um dementia it might tell us if you've had like some small Strokes um you know that would lean more towards like a basc dementia um a pet scin is another option um that's where they use a small amount of radioactive substance to measure your brain activity and it can also measure abnormal protein deposits in the brain so that might be helpful for some other types of dementia and then the last type is called a spec it's a single Boton emission computerized tomography and this is basically a nuclear test that looks at blood flow and activity so are there parts of your brain that that are either overactive or underactive and depending on what those are um that might give us an indication of whether it's like an anxiety or a depression issue if you know if it is something structural that's going to show up as well um but not as many people do those spec scans so it might be harder um to find one of those near you but it's always something that you've can ask your provider for and find out if your insurance covers it so that is a really quick overview of how Alzheimer's disease is diagnosed and you can get your free checklist um as well as some other resources like the 10 warning signs um but both of these things you can download for free um melissab phd.com diagnosis checklist is where you can get the list of of the six things that we just talked about and there is a hyperlink on that document to the 10 warning signs checklist as well as the episode about the 10 warning signs of Alzheimer's disease and the episode um right before this was um about seven medications that you need to avoid to improve um your brain and not causing any problems related to the Beers Criteria so um again I'm Dr Melissa Bachelor you can go to my website Melissa bd.com to sign up for my newsletter feel free to become a member right here on YouTube be sure that you subscribe like share leave a comment um because all those things do help get the word out to other people as well as improve the ratings of the of the podcast you can join my Facebook Community um called this is getting old moving towards an age friendly world where you can give me feedback and give me ideas for episodes that you would like for me to talk about but that's one way that we can interact with each other and otherwise thank you so much for tuning in and I will see you next week have a good one thank you so much for listening to this week's episode you can check out other episodes on this platform or or visit my website at melissab phd.com thanks to listeners like you in the first 18 months of this is getting old we have reached a ranking of top 10% globally and I cannot tell you how much I appreciate your support in getting making that happen I'm also really excited to let you know that you can now work with me directly either oneon-one or you can join one of the groups that I coach um particular if you're an adult child dealing with an aging parent or a caregiver trying to manage the complexities of someone living with Alzheimer's disease in the show you can also find information about how to reach out and contact me directly and I hope to work with each of you very soon as we discover and share more ways to make the world more age friendly for everyone my website also has information about how to contact me for speaking engagements or if you have someone you'd like to recommend as a show guest or this is getting old if you have a product or service in the Aging space that you would like to advertise um and or sponsor an episode there's more information about that on my website and you can also find books and courses I developed and learn more about the products and services that I recommend so don't forget if you like the podcast the best way to help me grow and support it is to like it share it and leave a review in whatever platform that you've tuned in on today your likes shares and reviews help increase my rating and my rankings and also help other people find the podcast I look forward to reading your reviews and hearing from [Music] you

Channel: MelissaBPhD

Views: 623

Keywords: aging, alzheimersdisease, how is alzheimer's disease and dementia diagnosed?, how is alzheimers disease and dementia diagnosed?, dementia, age friendly, healthy aging, caregivers, podcast, members only, alzheimers, alzheimersawareness, caregiver, dementia awareness, senior living, home care, healthcare, health, caregiver support, care, memory care, this is getting old, melissabphd, alzheimer's awareness, alzheimer's

Id: z1iVWZbEZ0M

Length: 20min 28sec (1228 seconds)

Published: Tue Feb 06 2024