As I’ve mentioned before, my mother was furious when a neurologist told her that she had Alzheimer’s disease after having her respond to a short battery of questions. She refused to believe the diagnosis and we barely were able to talk her into going to another doctor when her memory issues continued to worsen. Fortunately, this second neurologist did not jump to a quick conclusion. Instead, he recommended a battery of assessments that would help determine what might be the issue behind Mom’s memory loss.
It turns out that this second doctor’s take was in line with recommendations put forward by a recent task force that was put together by the Alzheimer’s Association. As I mentioned in an earlier sharepost, this taskforce recommended three specific screening tests that can be easily used by primary care physicians during the Medicare Annual Wellness Visit.
However, the task force also noted that those screening tests should be only the beginning of the analysis by healthcare professionals. The group recommends that patients whose assessments indicate that they may have some cognitive impairment during their Annual Wellness Visit should undergo further evaluation to determine an appropriate diagnosis. That diagnosis could very well be mild cognitive impairment, Alzheimer’s disease or another type of dementia or it could be caused by other issues, such as the ones I discussed in an earlier sharepost.
So what would that evaluation entail? “Components of a full dementia evaluation can vary depending on the presentation and include tests to rule in or out the various causes of cognitive impairment and establish its severity,” the task force members stated. Components can include:
- A complete medical history.
- Assessments that look at numerous cognitive domains, such as episodic memory (which is long-term memory that helps people remember specific events, situations and experiences), executive function (which is a set of mental processes that are used to connect past experience with current action through planning, organizing, strategizing and managing time and space), attention, language and visuospatial skills (which is understanding a familiar environment, such as remembering where the person placed personal items or remembering how to drive a car).
- Neurologic exam (which assesses a person’s gait, motor function and reflexes).
- The patient’s ability to function while doing activities of daily living and instrumental activities of daily living. Activities of daily living are those activities that are physical in nature and that are performed regularly. Examples of these activities including dressing, bathing and eating. Instrumental activities of daily living are activities that require both mental and physical capacity, such shopping, managing the checkbook, meal preparation and driving.
- An assessment to determine if the patient is depressed.
- Review of medications that may have an effect on memory and cognition.
- Laboratory tests that look at complete blood count, folate, metabolic panel, thyroid-stimulating hormone, and serum B12.
- An assessment for sexually transmitted diseases (such as syphilis or human immunodeficiency virus) if the patient is considered at risk for these conditions.
- A structure braining imaging scan, such as magnetic resonance imaging (MRI) or a computed tomography (CT) can be ordered as a supplemental assessment. The working group noted that these scans can be of assistance for patients who may be developing dementia that has recently begun and is rapidly progressing. In addition, these scans are helpful in early onset dementia for people under the age of 65 as well as for patients with a history of head trauma.
This battery of tests may lead to a diagnosis of Alzheimer’s disease or it could find that the memory loss is caused by other issues, such as medication interactions or head trauma. By having this full battery of assessments, a person who is experiencing memory loss can find out what really is behind their cognitive issues and an appropriate plan of action can be developed.
Primary Sources for This Sharepost:
Alzheimer’s Association – South Central Wisconsin Chapter, the Wisconsin Alzheimer’s Institute, and the Wisconsin Bureau of Aging and Long Term care Resources, Division of Disability and Elder Services, Department of Health and Family Services. (2004). Planning guide for dementia care at home: A reference tool for care managers.
Cordell, C. B., et al. (2013). Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimer’s & Dementia.
Johnson, N. , et al. (2004). The activities of daily living questionnaire; A validation study in patients with dementia. Alzheimer Disease & Associated Disorders.
National Center for Learning Disabilities. (nd). What is executive function?
Tulving, E. & Szpunar, K. K. (2009). Episodic memory. Scholarpedia.
Published On: January 07, 2013