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Dementia occurs in many forms; over 300 to be exact. Alzheimer’s Disease is just one of the many dementias healthcare professionals see daily.

The most common forms of dementia are Alzheimer’s Disease, Vascular Dementia (caused by strokes), and Dementias that are caused by disease (such as HIV, Parkinson’s Disease, Huntington’s Disease, Creutzfeldt- Jakob Disease, Pick’s Disease,  Hypothyroidism, Normal Pressure Hydrocephalus, Brain Tumors or Vitamin B12 Deficiency).

Dementia also involves much more than short term memory impairment. Sometimes the person with dementia is able to maintain a high degree of “socially appropriate” behavior and compensate for their deifcits.  Other times the behavior disturbance (such as wandering or agitation) is so obvious and its intensity so great that  it requires professional intervention to prevent the patient from being harmed.

Because other conditions can mimic dementia, it is always wise to seek a professional assessment to make a conclusive diagnosis. Many times, symptoms are present that can mislead the casual observer. The diagnosis is often referred to in the medical community as a diagnosis of exclusion, since we must rule out other conditions that are treatable. The SIU School of Medicine Center for Memory Disorders recommends the following medical tests to rule out medical causes for patient confusion: Complete blood workup, including blood chemistry, electrolytes, liver function, thyroid function test and a test called an FTA, which rules out late stage syphilis. In addition, a CT or MRI scan of the brain, Chest X-ray and complete social and work history are indicated. Sometimes a neuropsychological battery of testing is also performed by psychologists who are specially trained in diagnosing brain impairments.

Patients or their families are often the first to note signs of dementia. Frequent early complaints involve changes in functioning abilities, and common early symptoms include forgetting names and conversations, inability to manage finances and difficulty learning new skills. Behavioral changes such as personality change and agitation may also be evident. Symptoms that may indicate dementia are summarized below; the presence of any of these should trigger an assessment. Once the presence of dementia is suspected, history and physical exam should focus on four areas: determining if cognitive impairment is present, excluding delirium and depression, establishing its most likely cause and finally,  deciding if it is treatable or reversible.

	Learning and retaining new information: --  is repetitive;  --  has trouble remembering recent conversations, events,     appointments --  frequently misplaces objects
	Handling complex tasks --  has trouble following a complex train of thought or performing tasks that require many steps, such as balancing a checkbook or cooking a meal
	Reasoning ability  --  is unable to respond with a reasonable plan to problems at work or at home, such as knowing what to do if the bathroom is flooded; shows uncharacteristic disregard for rules of social conduct
	Spatial ability and orientation --  has trouble driving, organizing objects around the house, finding his or her way around familiar places
	Language --  has increasing difficulty with finding the words to express what he or she wants to say and with following conversations
	Behavior -- appears more passive and less responsive: --  is more irritable that usual;  --  is more suspicious than usual; --  misinterprets visual or auditory stimuli;  --  loss of insight in recognizingthere is a problem

In addition to failure to arrive at the right time for appointments, the clinician can look for difficulty discussing current events in an area of interest and changes in behavior or dress. It may also be helpful to follow up on an area of concern by asking the patient or family members relevant questions. It is important to ask family members to verify information that is provided by the patient, since the patient may have a distorted sense of his/her own abilities.

Apathy Scale-- Sample Items

• Does s/he tend to just sit and do nothing?
• Will s/he start activities on her/his own?
• Will s/he start to bathe on her/his own, without reminders or suggestions?
• Will s/he ask for food or start eating without reminders or suggestions?
• Are there things that s/he is enthusiastic about?
• Does s/he show interest in news about friends and family?
• Once s/he has started an activity, is s/he likely to lose interest in it?
• Does s/he seem indifferent to what's going on around her/him?

 If you are seeing these symptoms, a geriatric assessment is indicated. We can help you seek proper care for your loved one and help you create an environment that helps them continue to function at their highest level possible.

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