Understanding Diagnosis and Evaluation
Why it’s difficult to diagnose AD
Quite a few conditions cause dementia, or will mimic its physical, mental, and behavioural features. Indeed, initial symptoms like forgetfulness tend to be so subtle that they can be easily dismissed as signs of normal aging. In addition, symptoms can vary widely among individuals. A thorough clinical evaluation will rule out other possible diagnoses.
If you suspect that you or someone you care for has AD, talk to a doctor as soon as possible. Early diagnosis of AD and treatment may make a difference in slowing the progression of the disease. Medical evidence suggests that early diagnosis and treatment are instrumental in extending the patient’s ability to participate in activities of daily living (ADLs), as well as in making important medical, legal, and financial decisions about their future.
How AD is diagnosed: tools/examinations
AD can be diagnosed by a health care professional such as a primary care physician, neurologist, geriatrician, psychiatrist or geriatric psychiatrist.
The medical history and initial physical exam can be done during an office visit. More specialized testing will probably need to be done at a local hospital or radiology group. These tests, which allow doctors to establish a diagnosis of AD 80 to 90 percent of the time, include the following:
- Neuropsychological testing that measures memory, attention, counting, language, judgement, and problem solving.
- Taking a picture of the brain using a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or a positron emission tomography (PET) scan. These tests are relatively noninvasive (do not enter the body) and painless.
- Drawing samples of blood, urine, and in some cases, spinal fluid.
Stress relief for the patient
If a brain scan is ordered and claustrophobia (fear of enclosed or confining spaces) is an issue, make every effort to have this test done in what’s known as an “open” machine. In any event, bring a soothing audiotape or compact disc of your own choosing along to help you relax. Brain scans do not hurt, but they are noisy!
Stress relief for the caregiver
The evaluation process can be intense and emotional. It’s a good idea to have a trusted friend or family member along to listen and to take notes during appointments. This will free you up to ask questions and to feel whatever emotions will undoubtedly emerge as you learn more about AD.
How to prepare for a medical examination
Talk to a doctor as soon as you suspect someone may have AD. Primary caregivers, those who generally have the most continuous contact with the patient, should be prepared to alert the health care professional to the following:
- Changes in mental ability, attitude, personality, or patterns of behaviour
- Timing of observable changes (e.g., rapid or gradual onset of symptoms)
- All medicines —prescriptions, over-the-counter, or nutritional supplements —the patient is taking
- Complete medical history
It is also important for doctors to know about a patient’s background including the following:
- Alcoholism
- Chronic drug/medication abuse
- Depression
- Mental illness
- Nutritional deficiencies/eating disorders
To become better prepared for this medical experience, caregivers may want to:
- Educate themselves about AD. Learn as much as they can about this disease both on this Web site and by clicking on resources.
- Keep track of information by keeping a simple log or diary to share with the health care professional.
Current Treatment Options
Medical options today
In patients with AD, the amount of a neurotransmitter (or chemical) called acetylcholine (ACh) — essential for normal brain function — is reduced. Currently approved prescription medications for the symptomatic treatment of AD — called acetylcholinesterase inhibitors — inhibit the production of the enzyme (acetylcholinesterase) that breaks down or degrades ACh, thus increasing the amount of ACh that is available to the brain.
Natural supplements
Supplements are readily available at pharmacies and health food stores. There is research to suggest that certain vitamins and herbal supplements may have some impact on the progression of AD. Supplements, however, have not been studied extensively in clinical trials. Therefore, a physician should always be consulted prior to taking alternative therapies or supplements.
Additional disease-managing strategies
A comprehensive or complete strategy for treatment will go beyond medication to include other forms of therapy and palliative care. Like any other disease, AD affects body, mind, and spirit. The following can be included in a treatment plan for someone with AD. (If you’re a caregiver, you may want to seek some of this assistance for yourself as well.)
- Physical exercise
- Physical therapy
- Balanced, nutritious meals
- Psychological counselling
- Peer group support
- Activity programs
- Therapeutic bodywork such as massage
Palliative (pal-lee-a-tihv) care:
The goal of palliative care is to provide comfort and dignity for the patient. This is especially important during Stages 2 and 3 of AD.
Teamwork: You, Your Family, and Your Health Care Team
Developing a treatment plan together
Caregivers may rely on the expertise of health care providers, but health care providers also rely heavily on the observation skills of caregivers. Working together, caregivers and health care professionals are able to develop a treatment plan that best serves the needs of everyone involved.
By keeping a diary or observation log, caregivers can provide valuable information about the following:
- Changes in or patterns of cognitive and behavioural symptoms
- Reactions and responses to medications
- Shifts in ability to perform activities of daily living.
In addition to medical management, a comprehensive treatment plan will include strategies for dealing with deteriorating psychological and social skills. A complete team may also include a social worker, physical therapist, psychologist, home health aide, dietitian, legal counsellor and clergy — any of whom would be helpful at different stages of the disease process.
Communicating with family
Breaking this kind of news is never easy: Is it better to make a phone call? Convene a family meeting? Share books and videos? Write letters? Log onto e-mail? You may have to do all of these things. Remember that everyone has a different learning style or way of receiving information.
In addition, responses will vary depending on the relationship of the person with AD to others who need to know what is going on. It stands to reason that a spouse will have different concerns and reactions from someone whose parent, grandparent, in-law, or uncle is diagnosed with AD. Making decisions about who needs to know and when is part of appropriate communication. Shielding certain family members may or may not make sense. A social worker, counsellor, psychologist, clergy member, or primary care physician can help families negotiate the communication process.
At the least, the caregiver can assure other family members or friends that the disease advances slowly, allowing time to make plans to support the patient and each other during what will be a difficult, draining experience — both physically and emotionally.
As the reality of the diagnosis sets in:
- Everyone should try to become as knowledgeable as possible about AD. Share the information and resources on this Web site. It’s easy to print out information here and elsewhere on the Internet. AD support organizations also have useful material for families.
- Prospective caregivers will have a variety of feelings and responses. It’s common for family members to have a variety of reactions, or go through stages of denial, fear, and anger following diagnosis. Some family members may simply refuse to accept the diagnosis for a long time.
- There may be family members who, because of temperament, age, or life skills, will not be able to pitch in to the extent that the primary caregiver may wish. Knowing and accepting this in advance will reduce family friction and lingering resentments.
For information on caring for a loved one with Alzheimer Disease, click here
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