In the early 20th century, confusion in older people was viewed as a normal symptom of old age. However, as the population grew to live longer and advanced technologies enabled scientists to study and compare changes in the brains of healthy seniors and those with dementia, doctors realized that dementia is a disease state. The earlier it is diagnosed, the sooner treatments can be put in place to delay memory loss and subsequent confusion and related disability.
Defining Senile Dementia
The term "dementia" comes from the Latin words "De (meaning away) and "Mentia" (meaning mind). Senile dementia--as the name implies--affects the elderly population and presents with cognitive decline that is more severe than typical difficulties with short-term memory. The most common type of senile dementia is Alzheimer's disease, followed by cardiovascular related dementia. Alzheimer's disease cannot be definitively diagnosed until after autopsy. However, a variety of tests can be administered to make a likely diagnosis. Testing options include cognitive/memory tests, analysis of blood, urine or spinal fluid, and brain scans. Ruling out other possible conditions that cause memory impairment and confusion also contributes to making a diagnosis.
Cognitive/Memory Tests
Doctors use the "mini-Mental State Exam" or MMSE, to screen for decline in memory and cognitive abilities. It asks questions such as "what day is today?" and "what country are we in?" Patients are asked to do the following tasks that assess visual perceptual skills, abilities to make calculations and remember directions:
Read three items and repeat them
Count backwards beginning at 100, subtracting number seven repeated for a total of five times.
Spell the word "World" backwards
Look at a watch and say what it is
Repeat a phrase
Write a sentence
Copy a simple diagram
Another common screening tool is called the Clock-Drawing Test. The patient is asked to draw a clock and a specific time on it. When these two tests are given together more than 90 percent of patients with Alzheimer's disease can be correctly identified.
Medical Tests
Doctors begin by getting a medical history of the patient and family members. A history of arteriosclerosis and cardiac problems along with behavioral changes strongly suggests the cardiovascular form of dementia. Medical testing can rule out stroke as the cause of behavioral changes. Brain scans are performed to assess abnormal brain structures and activity. Head measurements to assess brain size also provide information that adds to a diagnosis.
Ruling Out Other Conditions
Routine blood, thyroid, liver function and other medical tests are performed to rule out illnesses that present with symptoms similar to dementia. Doctors will want to rule out anemia, side effects of medication and alcohol use as explanations for memory impairment and confusion. Depression can easily be misdiagnosed as dementia in an elderly person, and careful medical and psychological testing and evaluation of medications is required to rule it out.
Autopsy: The Final Test
Autopsy reveals the sticky plaques and tangles that spread over the Alzheimer patient's brain. An autopsy confirms the clinical diagnosis or reveals other diseases that mimic dementia. Family members may request an autopsy to better understand the loved one's behaviors, decline and ultimate death.
References
- "Still Giving Kisses: A Guide to Helping and Enjoying the Alzheimer's Victim You Love;" Barbara A. Smith, M.S.; 2008
- "What If It's Not Alzheimer's?;" Lisa Radin & Gary Radin; 2003
- "The Forgetting;" David Shenk; 2001
