Recognition and Diagnosis of Dementia - Essay Example

Recognition and Diagnosis of Dementia The burning question for this paper concerns an issue regarding elderly people who may be experiencing loss of mobility, forgetfulness, personality disorder, fearfulness of others, and hallucinations (Jeffries & Agrawal, 2009). The question in PICOT review, therefore, is the following: “In elderly people (P=70+), how are cognitive skills measured in dementia and potential Alzheimer’s disease (I=Issue), as compared to younger adults (C), affect the lifestyle of those diagnosed (O), and how long before a diagnosed patient is no longer legally or medically functional (T)?” (Melnyk & Fineout-Overholt 2011). Dementia in the elderly is a very difficult issue to handle as older people (parents, siblings or even marital partner) may not want to be tested for this (Lloyd, 2014). Older people feel more vulnerable, not only physically, but particularly if they find themselves having trouble remembering things easily, are frustrated when they cannot do things like they used to, and feel threatened by those around them (White, White & Smith, 2014). Perceptions of situations and relationships may change, causing problems in family and financial situations, and elderly people may take less care of themselves, such as in bathing and other personal grooming habits. All around, it can become very difficult and families, then, must ask for help from the medical and legal community. Normal changes in elderly people are that they have slower thinking and problem-solving processes, may not pay close attention and concentrate like they used to, and have a harder time recalling people or events that occurred in their lives (White et al., 2014; Patient, 2014). Other typical issues are that they may take time trying to find the right word and have some signs of forgetfulness, but still have the same personalities and still remember important events and conversations. Dementia, however, comes in a number of packages, with occasional overlays between two or more diagnosis. For example, in less common forms of dementia, there is Pick’s Disease, Creutzfeldt-Jakob’s Disease, Huntington’s Disease, Parkinson’s Dementia, or Lewy Body Dementia. In a combination of Pick’s Disease, which tends to be more common in women, and Lewy Body Dementia, an elderly female can have hallucinations about things that are happening or she thinks are happening, and she can also become extremely fearful of someone when there was no cause for that thinking process (White et al., 2014). Therefore, it is essential to have a diagnosis made so appropriate treatment can be started and the elderly can live a more healthy and happy life. Families may see the first signs of dementia but not fully understand what it is (Jeffries & Agrawal, 2009). A primary care physician (PCP), however, may see the same symptoms and realize that tests need to be made to determine for sure what is happening. Yet, in a growing society of elderly people (baby boomers, for example), primary care doctors may not have the time or skills to conduct those tests, nor may there be enough dementia specialists to assist in helping out this situation. Many elderly people, who need help, may fall by the wayside, as a consequence (Jeffries & Agrawal, 2009). Current diagnosis are based on guidelines provided by the National Institute of Neurological, Communicative Disorders and Stroke-Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA) (Galvin & Sadowsky, 2012). There are three levels of determination: definite, probable and possible, with the last level made without any diagnostic biomarker. The definitive level of diagnosis only occurs when there is a histopathologic confirmation of clinical diagnosis, as required by NINCDS-ADRDA. The probable level, however, is usually only confirmed through autopsy at a current rate of 86% to 90% of those cases (Galvin & Sadowsky, 2012). Magnetic resonance imaging (MRI) of the brain will show changes over time, particularly in the medial temporal lobe, as well as molecular changes using positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers which also show changes (Galvin & Sadowsky, 2012, p. 368). These are more prevalent now in determining whether an elderly person has any symptoms of dementia, yet it does require approval of the patient to undertake these tests, and also approval of the medical insurance company that covers the patient. These tests can take place at the point where a patient exhibits significant episodic memory impairments. However, it is unclear if it is only the PCP who determines that or if the patient’s family must provide the information in order for the testing to begin (Jeffries & Agrawal, 2009; Lloyd, 2014). Additionally, there are still no absolute biomarkers, specific laboratory tests or MRIs which are specifically designed to be used regularly, certainly by PCPs. The PCP can conduct in-office tests through two methods: the performance measure which is then compared to a published standard of normalcy for other similar patients of that age. This, however, would have to be conducted over time as the changes could only be seen under such conditions. The Mini-Mental State Examination (MMSE) test provides an initial assessment which can be used by the PCP. A better test is the Mini-Cognitive Assessment Instrument (Mini-Cog) in recognizing cognitive impairment (Galvin & Sadowsky, 2012). There is also the Montreal Cognitive Assessment (MCA), which has a greater sensitivity in detecting MCI and is less problematic in concerns with cultural and educational biases. It is also free for download and has an easy scoring system to test multiple cognitive areas. The second tool for the PCP to use in a clinical setting is to conduct an informant interview with someone who has known the patient for some time and would verify if any changes had taken place, particularly if those changes have interfered with daily living functions. The informant can take the Ascertain Dementia (AD8) first, before the interview, to provide information and this test can also be taken by the patient as a self-rating tool (Galvin & Sadowsky, 2012). In such a situation, a family caregiver becomes very important to the well-being of the patient and help can also be obtained from the American Academy of Neurology (AAN) and American Association for Geriatric Psychiatry (AAGP) to provide information and to encourage partnership with the PCP. There is obviously a greater need for more research and testing to find better effective ways to diagnose dementia and potential Alzheimer’s disease and to build the research library with more tools and information for other medical practitioners (Melnyk & Fineout-Overholt 2011). This issue will obviously become bigger as more elderly people live longer than in previous decades. Resources Galvin, J.E., & Sadowsky, C.H. (2012). Practical Guidelines for the Recognition and Diagnosis of Dementia. Journal of the American Board of Family Medicine, 25, 367-382. Retrieved from http://www.jabfm.org/content/25/3/367.full.pdf+html. Jeffries, K., & Agrawal, N. (2009). Early-onset Dementia. Advances in Psychiatric Treatment, 15, 380-388. Retrieved from http://apt.rcpsych.org/content/15/5/380.full.pdf+html. Lloyd, B.K. (2014). Identifying Early Indicators of Subjective Memory Concerns in Seniors. (Thesis). Retrieved from https://www.ruor.uottawa.ca/en/bitstream/handle/10393/30920/Lloyd_Brittany_2014_thesis.pdf?sequence=1. Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing & Healthcare (2nd ed.). Baltimore, MD: Wolters Kluwer Health. Patient. (2014). Memory Loss and Dementia. Patient.co.uk Online. Retrieved from http://www.patient.co.uk/health/memory-loss-and-dementia. Wayne, M., White, M., & Smith, M. (2014). Understanding Dementia. HELPGUIDE.org Online. Retrieved from http://www.helpguide.org/elder/alzheimers_dementias_types.htm. Read More