Friday, April 30, 2010

There are always precipitating suspicions of Alzheimer’s  or dementia before someone is taken in for an evaluation. Some memory loss is natural as we age. God knows if I don’t write it down, I will forget. When I family notices memory loss, there always seems to be the question of whether the memory loss is “normal” or something more.

If you suspect Alzheimer’s or dementia in a family member, it will be important to prepare for an evaluation. Don’t procrastinate in getting an evaluation out of fear. Many things can cause memory loss, and no matter the cause, you will want whatever treatment is necessary or available, as soon as possible.

Monitor and objectively document what causes your suspicion. This will be extremely important to take to an evaluation.

a. When did you first notice memory loss?

b. Was the memory loss short term or long term? We can all forget what we had for dinner last night, or details from childhood. More indications of short term memory would be forgetting to eat, not knowing the day or time, forgetting to bathe or getting lost, and repeating the same questions, sentence or conversation.

c. Is your loved one able to take care of their activities of daily living (ADL’s)? Bathing, grooming, meals, household chores, and managing medications are key components indicating abnormal memory.

d. Can your loved one attend to their finances? This is often an early indication of something more than normal memory loss.

e. Is there a marked weight loss? Although weight loss can be an indication of a physical problem, when combined with noticeable memory loss, this can be a sign of missing meals due to memory loss.

f. Are there physical symptoms in addition to notable memory loss? Many physical conditions can involve memory loss or confusion. The elderly can experience confusion with a urinary tract infection, so it is very important to note any physical changes or problems.

• Gather all medical information.

a. Medical history, including diagnosis, surgeries, and hospitalizations.

b. All medications, including over the counter medicines and vitamins or supplements.

c. Insurance information

• Choose and make an appointment with the physician for an evaluation

a. If you are comfortable and confident in the primary physician, you may want to begin making an appointment with him/her, if your loved one has been a long time patient who the physician is very familiar with.

b. If your loved one does not have a primary physician who is longstanding or who you lack confidence in, it’s best to first go to a geriatric specialist. Ask around to family and friends for a referral. Getting a trusted family member or friend to recommend a physician they have experience with and confidence in is always preferred. If you are unable to get a personal referral, most hospitals now have senior health departments with geriatric physicians.

c. If your initial evaluation is with your primary physician, who is not a geriatric specialist, I recommend a second opinion with a specialist if Alzheimer’s or dementia is diagnosed. Many physicians are quick to diagnose these illnesses, without the expertise of geriatric medicine.

Take all test results from the evaluation with the primary to the appointment with the specialist, to avoid some repetitious testing.

• When you call for an appointment ask what is included in an evaluation for Alzheimer’s or dementia.

a. You will want to know that a full physical workup will be done with psychological testing, and a memory screen.

b. Ask if the physician has a treatment plan if a patient is diagnosed with Alzheimer’s or dementia. If you hear, “what do you mean” then you know this is not the physician you want to make an appointment with.

c. Inquire whether the physician has resources for education and support. You and your family member will need immediate education, if Alzheimer’s is the final diagnosis. You will also need resources for support and assistance as the disease progresses.

The evaluation won’t be a quick process. It may take time to get an evaluation appointment with a specialist, so it is best to find a specialist and call for an appointment when you initially suspect Alzheimer’s or dementia.

While waiting for the appointment, you can monitor and document the objective data above. It takes time for all of the lab tests to be completed to rule out other causes of memory loss. As you and your loved one go through the evaluation process continue to monitor and document any changes you didn’t already provide the physician in the appointment. The more information the physician has the better, for an appropriate diagnosis.

Angil Tarach can be reached for questions or comments by email, or for more information about Visiting Angels

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