Dementia Diagnosis and Assessment

Dementia Diagnosis and Assessment

The brain and dementia

The brain is the control centre of our body and gets messages from our senses that see, hear, taste, smell, touch and move. The brain is divided into different parts called lobes and each lobe does special things. If any part of the brain is sick or damaged it will not be able to do the work that is required by that area.

Dementia unfortunately changes things in the brain including people having problems with their memory. Memory is important to all of us in how we live our day to day life. It is certainly normal for us to forget things once and a while and most of us become a little more forgetful as we age. But forgetting how to find your way home, the names of family and friends or how to do everyday tasks might be signs of dementia.

Although dementia occurs more often as people age, it is NOT a normal part of ageing and unfortunately young people can get dementia too.

Assessing and diagnosing dementia

Timely assessment and diagnosis is important in the management of dementia, planning for the future and for financial and legal decisions. If someone you care about is showing some signs of concern you need to:

  • Talk to a family member, carer or health worker for additional support.
  • Organise to take your loved one to see a doctor, Aboriginal and Torres Strait Islander Medical Service or Aboriginal and Torres Strait Islander Health Worker. Medical assessment should be done with a close family member or friend.
  • Explain the full history of what you have observed and what has been happening.
  • Support a full medical check-up including a check-up of memory (this may include having some special tests and X-rays done).
  • See someone who can organise some cognitive and memory tests, for example the KICA assessment. This is a tool designed for Aboriginal and Torres Strait Islander people in the Kimberley region and has been modified for Aboriginal and Torres Strait Islander people in urban areas. For more information on the KICA assessment please visit the Western Australia centre for Health Ageing.
  • CT Scans or MRI Scans of the brain.
  • Follow up results for directions and advice for the future.

Everyone’s experience of dementia is different, and we can’t predict exactly how someone will progress after receiving a diagnosis. However, it is important to note that a diagnosis of dementia does not always mean a fast decline in memory and other abilities. Everyone’s progression is different, and people with dementia can live a fulfilling life for many years after a diagnosis.

Other Memory concerns

Dementia is not a normal part of ageing, and is also different from short term confusion or mental illness. There are many treatable medical conditions that look like dementia. People can get treatment for these conditions and the person will often get better. Examples include delirium and depression. Therefore it is important to go for a check-up and seek medical advice.

Delirium

Delirium is a short term medical condition that can result in confusion and sudden changes in cognition. It is different from dementia as it usually develops over a short period and generally changes during the day. For a person with delirium, focus is reduced; they may have problems with attention, may have problems with sleep and changed psychomotor behaviour (for example going back and forth between being tired and drowsy to restless and agitated). Some causes of delirium could include infections, or effects of medication or anaesthetic (for example after an operation). People can usually get treatment for these things, so it is important to get help as soon as possible.

A sudden change in the person’s normal behaviour and cognitive symptoms is an important indicator of delirium (DTA Online Course: "The View from Here").

Depression

Depression is when a person feels sad, moody or low for a long period of time (weeks, months, or years). Some typical signs of depression include:

  • Loss of interest and pleasure in previously enjoyed activities
  • Lack of energy
  • Poor sleep
  • Loss of appetite and weight
  • Expressing feelings of worthlessness
  • An unusually sad or irritable mood that does not go away
  • Being unusually emotional, crying, angry or agitated
  • Increased confusion
  • Thinking about death a lot or wishing they were dead
  • Difficulty concentrating or making decisions
  • Moving more slowly or, sometimes, becoming agitated and unable to settle
  • For further information on depression please visit the beyondblue Depression, Anxiety website.

    Differentiating between Dementia / Delirium / Depression

    Sometimes people may present with symptoms that look like dementia but may in fact be depression or delirium or a combination of these.

    Good assessment by a doctor or Aboriginal and Torres Strait Islander Medical Service or Aboriginal and Torres Strait Islander Health Worker is necessary to tell the difference, but some of the similarities and differences in symptoms are in the table below:

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    Features Depression Delirium Dementia
    The time it takes to occur

    Weeks to months

    Hours to days

    Months to years

    The course

    Chronic,but responds to treatment

    Very sudden and acute but can respond to treatment of cause

    Chronic with slow deterioration over time

    Memory /cognitive change

    Reduced memory, concentration and thinking, low self-esteem

    Fluctuations in alertness, cognition, perceptions, thinking

    Cognitive decline with problems in memory plus another type of thinking problem (e.g. word-finding and communication problems, difficulty recognising things, poor concentration, planning and problem-solving)

    Self-awareness of problem

    May be worried about memory loss

    Might be aware of changes but fluctuates

    Likely to try and hide changes or be totally unaware of changes taking place

    Caring for self

    May neglect basic self-care

    May or may not change

    May be able to care for self initially but deteriorates over time

    Sleep

    Disturbed
    Early morning wakening

    Disturbed – but no set pattern – may have extreme nightmares – differs night to night

    Very individualised sleeping changes occur over time

    More information about depression in Aboriginal and Torres Strait Islander people can be found at: https://mhfa.com.au/sites/default/files/AMHFA_depression_guidelines_email_2012.pdf

    More information about delirium can be found on the following sites:

    http://health.gov.au/internet/main/publishing.nsf/Content/FA0452A24AED6A91CA257BF0001C976C/$File/Delirium%20poster%20A4.pdf
    https://www.aci.health.nsw.gov.au/chops/chops-key-principles/undertake-cognitive-screening/screening-patients

    How do I get help and what help is available to me?

    You can initially seek assistance and guidance through your General Practitioner, your Aboriginal and Torres Strait Islander Health Worker, or your Aboriginal and Torres Strait Islander Medical Service.

    You might also seek guidance and support from Dementia Australia through the National Dementia Helpline on 1800 100 500 or look at specific resources on dementia in Aboriginal and Torres Strait Islander peoples on https://www.dementia.org.au/resources/for-aboriginal-and-torres-strait-islander-communities

    My Aged Care is the actual starting point to accessing and using Australian Government funded aged services. You can access them on 1800 200 422.

    My Aged Care can provide information about:

    • The types of aged care services available
    • What your eligibility for services is
    • What service providers are in your area
    • Costs you may need to pay
    • Advocacy services
    • How to make a complaint about aged services

    For specific information regarding aged services for Aboriginal and Torres Strait Islander people (including a small animated instructional video) please go to:
    https://www.myagedcare.gov.au/eligibility-diverse-needs/aboriginal-andor-torres-strait-islander-people

    If you have difficulty with accessing My Aged Care contact your local clinic for assistance.

    Medical Treatments for Dementia

    Presently there are no medications available to ‘cure’ dementia.

    However, there are treatments available that may help relieve the symptoms associated with dementia.

    As with all medications, people can experience side effects. People should talk to their doctor about potential side effects, and if they experience any side effect while taking a medication, check in with their doctor.

    Drugs that can help with cognitive symptoms of dementia (e.g. memory, awareness, ability to function)

    • Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine.

      These medicines are commonly prescribed for mild-moderate Alzheimer’s disease but can also help in other types of dementia (e.g. Dementia with Lewy Bodies, Parkinson’s disease dementia, Vascular dementia and Mixed dementia).

      They work by preventing the body breaking down a substance called acetylcholine, which plays a role in how brain cells communicate with each other. Side effects can include nausea, loss of appetite, diarrhoea and slow heart rate.

    • Memantine

      This medicine is most often used for moderate or severe Alzheimer’s disease but can also be used for other types of dementia (or if someone cannot tolerate acetylcholinesterase inhibitors).

      It works by inhibiting (or blocking) the effect of a substance called glutamate.

      The most common side effect is dizziness.

    Drugs that can help with Behavioural and Psychological Symptoms of Dementia (BPSD)

    Behaviour changes can be distressing for both people with dementia and their carers. In all cases, attempts should be made to find out what else may be causing the symptoms e.g. an infection, untreated pain or a recent change in medication/environment.

    It is useful to discuss expected side effects and benefits of any medications that may be started and if possible, to aim for the lowest dose possible, for the shortest time possible.

    • Antidepressants e.g citalopram, mirtazapine, sertraline, duloxetine.
    • Symptoms of depression (low mood, poor sleep, reduced appetite) may occur in persons living with dementia.
    • Anti-anxiety medications e.g oxazepam, lorazepam.
    • Anxiety can be a prominent symptom of dementia.
    • Antipsychotic medications e.g. risperidone, haloperidol, quetiapine.
    • These drugs are mostly used for behaviours that are causing distress such as aggression, delusions and hallucinations.
    • Medications to help with sleep disturbances e.g melatonin.
    • This medication has been shown to have some benefit in restoring regular sleep patterns.
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