Review of Medical History
The most common reasons that you or your loved ones will think about seeking a diagnosis of dementia is because you’ve become more confused of late or your short-term memory is lacking, however there can be other behavioural changes and difficulties that can signify that you may be living with a form of cognitive decline. These can include an inability to manage daily tasks as you once did, communicate effectively, or conduct yourself appropriately in social situations.
Dementia is the ‘umbrella’ term for the cognitive decline that results from over 100 different conditions, of which Alzheimer’s disease is the most common, but which also includes vascular, Lewy Body, frontotemporal and mixed dementias. It’s important to speak to your GP if you’re exhibiting any of the signs of potential dementia, as other conditions can also cause similar symptoms.
Dementia UK tells us that “There are many different conditions that can mimic the early signs of dementia including: infections, delirium, vitamin deficiency, depression, anxiety, diabetes.” Consequently, having your medical history examined closely by your GP can illuminate other causes and when they have been eliminated a diagnosis of dementia can be pursued.
Mental Status Exams
Mental Status Examinations are used to assess a person’s mental health and cognitive function but are just one part of the assessments that can be carried out to diagnose dementia. Mental Status Exams will contain an array of questions, observations and tests that will be scored and then used to assess memory, attention and language.
What Is A Mental Status Exam
A Mental Status Exam can be utilised as part of the process for diagnosing dementia, to discover the progression and severity of the person’s cognitive decline. It examines several aspects of a person’s demeanour, appearance and ability to communicate, and is organised into five headings: General Appearance, Emotions, Thoughts, Cognition, Judgment and Insight.
This could be a crucial indicator that something isn’t right with a person’s mental state, because as Brown University puts it, “if a patient presents looking dishevelled…but a note from only a month ago reports the same patient to have been well dressed and groomed, something is going on!” Motor behaviour, speech and attitude should also be closely observed.
Mood and effect will be examined, with terms such as anxious, terrified, sad, depressed, angry, euphoric, and guilty used, although it’s advisable for vaguer terms like ‘upset’ or ‘agitated’ to be avoided.
Coherent thought patterns will be examined to see if the person is able to follow a stream of thought effectively. The person will be questioned about whether their thoughts are ‘racing’ or whether their thoughts jump from one topic to another without any obvious coherence. Perceptual disturbances such as hallucinations or delusions may also present.
Thinking, logic and reasoning are higher level functions that we are able to use coherently when not struggling with cognitive decline, and the way we communicate with others is one of the ways this can be examined. Awareness of place and time, attention span, concentration and memory will all be tested to see if the person can function effectively.
Judgment and Insight
Judgement and Insight can be examined together in many examples, for instant, in the context of whether the person recognises they are ill. For them to be able to do this means they must have insight into their situation, but also, to understand the causes of their illness and to seek appropriate solutions takes judgement.
How Is This Exam Performed
According to Dementia UK, the exam will be performed by “a psychiatrist with experience in dementia, a doctor specialising in elderly care (geriatrician) (or) a doctor specialising in the brain and nervous system (neurologist).” A common test that can be utilised as part of the larger Mental Status Exam is known as the ‘Folstein Mini-Mental Status exam’, which contains questions such as “What is the (year) (season) (date) (month)?”, “Asking the patient to count back by sevens, starting at 100” and “Following a 3-stage command, such as ‘Take a paper in your right hand, fold it in half, and put it on the floor.”
The results from all the tests are then scored against baseline results and although they are not sufficient on their own to diagnose dementia, they can be used in conjunction with other tests such as blood tests and brain scans.
Images taken of the brain can be a viable tool in the diagnosis of dementia and can be used in conjunction with Mental Status Exams and other tests to accurately identify cognitive decline. Brain scans can also offer insight into what might be causing symptoms if dementia isn’t the cause, such as a stroke or brain tumour, and in this case a CT scan rather than an MRI scan would most likely be used.
The NHS tells us that an MRI scan is recommended to assist in a diagnosis of dementia and what disease is causing the dementia, such as “the blood vessel damage that happens in vascular dementia” or “shrinkage in specific areas of the brain.” This is because in frontotemporal dementia the frontal and temporal lobes are mainly affected, whereas “just the temporal lobes are affected in the early stages of Alzheimer’s disease.”
Arranging After Care Following A Diagnosis
Once you have received a diagnosis of dementia you should have a care plan devised for you. Depending on what part of the country you live in it could be the local authority, memory clinic, or GP who devises it for you. Family members and carers will also be involved if you wish, and the care plan should contain information on how to access local services, the details of the significant healthcare professional who is coordinating your care, any health conditions you already have and how you can continue to live your best life possible for as long as possible.
Dementia Care at Home from Helping Hands
While you may not need care at the beginning of your dementia journey, there will come a time that you will require some extra support to live your life well with your dementia. Your care may be initially delivered by family members but eventually you will need the support of a dementia specialist company who can provide excellent care. Remaining at home for your dementia care rather than moving to a care home will benefit you emotionally as well as physically, because by staying in familiar surroundings, with people, pets and possessions that mean the world to you will hopefully help to keep confusion and anxiety to a minimum.
Helping Hands can support you on a visiting or live-in basis, with every aspect of your daily routine covered, and our compassionate cares will do everything they can to ensure you live your best life possible. Because we check the backgrounds of our carers thoroughly and screen them through the DBS, you and your loved ones can be reassured about who is coming into your home, and thanks to us being fully regulated by the Care Quality Commission and Care Inspectorate Wales, you know our standards of care will always remain the highest.
If you’d like to learn more about dementia care with Helping Hands then please call our friendly customer care team seven days a week, or alternatively contact us via our website and we’ll be happy to call you back.