Dementia tests - A guide to testing dementia in adults
Dementia is complicated, as much as it is debilitating. We already know this by now thanks to research. Aside from that, you would be surprised by how common it is. Let’s look at the facts. Approximately 50 million people all around the world have dementia and there are around 10 million new cases every year. These are huge numbers. According to the Dementia Australia foundation, the number of patients currently living with the disease in Australia is 472,000 as of 2020. This number is estimated to rise by 250 new cases every year, reaching 590,000 cases by 2028. To make things worse, it is the second-largest cause of death for Australians. Those are rather unnerving statistics.
That brings us to the focal point of this article: early signs of dementia and diagnostic tests. Fortunately, there are early indicators or signs that may reveal the development of the disease. You could call these “warning signs”. It is important that you pay attention to these warning signs and take a dementia test. This way you can start treatment early before the disease gets worse. Keep reading to find out what these signs are.
What does Dementia do to you?
The term dementia doesn’t refer to one single disease. It is an umbrella term for the symptoms of a range of progressive neurological disorders. Most of them affect a person’s memory, cognitive abilities, and behavior. Correspondingly, the condition also affects a person’s ability to do normal day-to-day activities.
Dementia is progressive and gets worse over time. Patients in their final stages experience drastic memory loss, difficulty communicating, and the inability to do even the simplest tasks by themselves. At this stage, they would have to rely on caretakers or their families for care. Additionally, dementia care homes are now widely available for patients with the condition. These care homes are a good choice for many reasons. For instance, they are safe and usually have a well-trained and equipped 24-hour support and care staff. Care homes also provide grounds for patients to get involved in social activities with other residents which is great for their mental well-being.
Stages of Dementia
The progression of dementia generally goes through seven stages. However, it is difficult to say exactly which stage a patient is in because the stages can overlap.
Stage one: no impairment
There will be no visible problems at this stage. Only testing would produce any noticeable warning signs.
Stage two: very mild cognitive decline
The patient will start to show slight memory problems or changes in behavior. Often these signs are subtle and can go unnoticed. For instance, forgetting everyday phrases and names or frequently misplacing belongings.
Stage three: mild cognitive decline
This stage is where the condition starts being noticeable to people in the patient’s life. Regardless, the condition won’t have a significant impact on the patient. Signs include,
- Trouble completing complex tasks and solving problems.
- Having a hard time recalling or remembering recent events.
- Repetition of speech or asking a lot of questions.
- Decreased work performance.
Stage four: moderate cognitive decline
Signs of cognitive decline become more and more obvious. Patients go through social withdrawal, become moody, non-responsive, and have trouble with routine tasks.
Stage five: moderately severe cognitive decline
Patients begin to need support with their usual routine tasks, such as dressing and bathing. In addition, they tend to forget important things like their grandchildren’s names. Consequently, patients at this stage require the assistance of a caregiver or have to move to a dementia care facility.
Stage six: severe cognitive decline
This stage is also known as middle dementia and is the longest stage. On average it lasts for about two to four years. Patients may forget the name’s of their spouses and family members. Simultaneously, they may also require help for Activities of Daily Living (ADLs) such as eating or bathing. Common symptoms of this stage are,
- Inability to recognize loved ones.
- Increased paranoia and delusions
- Repetitive or obsessive behavior
- Increase in aggression and irritability
Stage seven: very severe cognitive decline
The final stage of dementia. Patients will no longer be able to care for themselves and even lose their ability to walk and talk. This is because motor and communication impairment is common at this stage.
What causes dementia?
Dementia is complex. The term “dementia” itself doesn’t refer to one single condition. It’s an umbrella term that refers to symptoms caused by a range of conditions and neurodegenerative diseases. The most common cause of dementia is Alzheimer’s disease, accounting for 60-70% of all dementia cases. It is a progressive neurological disorder that causes brain atrophy (shrinking) and kills brain cells.
Similarly, other types of progressive dementia include vascular dementia, Lewy body dementia, and frontotemporal dementia. Surely, these terms seem complicated. Let’s simply look into what they are. Vascular dementia is the second most common type of dementia accounting for around 5% to 10% of all dementia cases. It is a result of damages in tiny blood vessels that deliver blood to the brain, which reduces blood supply to some areas, killing brain cells. Common causes of vascular dementia include high blood pressure, diabetes, and high cholesterol levels. If you are suffering from any of these medical conditions, it is important to frequently visit your general practitioner and get proper medical treatment.
Lewy body dementia is a result of the buildup of abnormal balloon-like clumps of protein in brain regions involved in thinking, memory, and movement. Hallucinations are a common symptom of this type of dementia. On the other hand, frontotemporal dementia stems from the degeneration of brain cells in the frontal and temporal lobes of the brain.
Additionally, traumatic brain injury can cause dementia. A 2016 study published in Neurodegenerative Disease Management indicated that traumatic brain injury is a risk factor for dementia and more specifically, Alzheimer’s disease. TBI is fairly common in sports such as boxing, wrestling, and football. If you play any of these sports, you may want to be careful and wear enough protection.
Reversible causes of dementia
Certain types of dementia can be reversible depending on the root cause. Lets take a look at a few of these,
- Dementia as a result of chronic drug use: over time the use of drugs takes a significant toll on brain function and brings about cognitive impairment.
- Dementia caused by brain tumors: tumors in the brain, invade brain tissue and disrupt cognitive functioning. In addition, they may also lead to personality changes.
- Hydrocephalus: a buildup of fluid around parts of the brain resulting in symptoms similar to dementia.
A silent killer
Dementia is deadly. However, due to high prevalence rates among the elderly, it was initially brushed off as a part of the normal aging process. We now know that it, in fact, isn’t. On average, it is mostly seen in people over 65 years of age, nonetheless, early onset of the disease can sometimes be seen in people in their 50s, 40s, or even ’30s. In 2017 dementia was the leading cause of death for Australian women and the third leading cause of death for men. On the whole, the estimated death toll was around 13,729 with 65% of these being women. These numbers may have had a significant increase by now.
That’s not the only bad news. Dementia has no cure. Not right now at least. Besides, the invention of one single cure is rather unlikely because it stems from a range of other individual conditions. Currently, research on dementia is focused on finding a cure for conditions that cause dementia such as Alzheimer’s disease. Nonetheless, if you are suffering from dementia or has someone in your family who’s suffering from it, this shouldn’t stop you from getting treatment or make you feel like there is no point in treatment. Some types of medication can really help.
It is important to take a dementia test as soon as any symptoms appear. Why? Treatment works for some types of non-progressive dementia. On the other hand, it gives the patient’s the ability to decide what kind of treatment they want to go with and also gives them enough time to let their family and friends know about the changes that will be happening in their lives. Consequently, Visiting your doctor is the first thing to do if you are experiencing any changes in cognitive function, movement, or behaviour.
Having said that, if your doctor suspects that you may have dementia or any of the conditions that cause dementia, you will most likely be directed towards a health professional who specializes in the treatment and diagnosis of the condition. Usually, this would be a neurologist, a psychiatric or mental health expert.
There are three components to a typical medical assessment of dementia,
- Medical history: an assessment of a patient’s medical and family history. The doctor will want to know if dementia runs in the family, the nature of the symptoms, and when they started. Furthermore, they may ask questions about any medication the patient is taking which could be worsening symptoms.
- Physical exam: these tests assess the overall health of the patient. In doing so, the doctor can rule out any medical conditions that may be causing dementia-like symptoms. For instance, checking blood pressure, hormonal level, and vital signs.
- Neurological tests: A patient’s cognitive function, coordination, reflexes, and balance are assessed through these tests. They help identify other conditions aside from Alzheimer’s that may be causing the dementia symptoms. For instance, signs of stroke, Parkinson’s disease, and brain tumours.
Types of dementia tests
Each component of the dementia assessment is incorporated with certain types of tests. Present below are some common tests that patients may have to through before a dementia diagnosis.
Cognitive and neuropsychological tests
These types of tests assess a patient’s memory, problem-solving skills, mathematical skills, and other cognitive abilities. Usually, patients must complete these tests at the doctor’s office on paper or on a computer. Alternatively, the doctor may ask them to provide verbal answers to a series of questions.
MoCA (The Montreal Cognitive Assessment) and MMSE (The Mini-Mental State Examination) are two of the most common cognitive assessments used by medical health professionals at the moment. They are both short and have a 30 point scale, however, the MMSE is slightly shorter and takes 7-8 minutes to administer. MoCA takes between 10 and 12 minutes. Both tests are not very detail-oriented and are only useful for preliminary screening. Many clinicians administer both tests along with a range of others.
MoCA is highly sensitive and is able to pick up certain things that the MMSE may miss. Additionally, it differentiates very well between normal cognition and mild impairment or dementia. For instance, it picks up subtle cognitive deficits in Parkinson’s patients. MMSE can not do this. However, for severe cases of dementia, the MMSE is a better test.
Another widely used test is the Mini cog test. These tests are rather simple and only take around 3 minutes to administer, which makes them an effective tool to identify patients who need more thorough testing. During the test, a patient is asked to complete two simple tasks,
- Remember three unrelated common words (eg: banana, sunrise, chair) and repeat them again when asked in a few minutes. Patients have three tries to get it right and the doctor then moves on to the next task.
- Draw a face of a clock with all the 12 numbers in proper positions and then draw the hands to tell a certain time specified by the doctor.
These are not necessarily dementia tests, instead, they are used to rule out any alternative roots for the symptoms. To illustrate, a patient’s blood and bodily fluids are examined to look for any changes in the levels of certain hormones, chemicals, and vitamins.
Scanning is specifically used to inspect the brain for strokes, tumors, injury, and other problems that can cause dementia. Not everyone needs to go through a scan. They are avoided If previous tests provide enough evidence of dementia. The most common types of scans are,
- Computed tomography (CT): these scans combine X ray-images taken from different angles and computer processing to create cross-sectional images of the brain.
- Magnetic resonance imaging (MRI): uses a strong magnetic field along with computer-generated radio waves to produce detailed images of the brain.
- Positron emission tomography (PET): Unline the other two scans on the list, PET scans for functional changes in the brain instead of structural ones. When doing a PET scan, a patient is first given a special dye containing a radioactive tracer. The tracer is swallowed, inhaled, or injected depending on the target body organ. It is then absorbed into the body allowing the scanner to make an image of the metabolic processes in the required area.
Some patients might have to take an X-ray. This is not a standard part of the testing process and is usually recommended for patients who are heavy smokers to rule out the possibility of lunch cancer that may have caused a secondary tumor in the brain.
Psychiatric conditions can sometimes produce similar symptoms to dementia. For instance, symptoms of clinical depression such as social isolation and forgetfulness can also be seen in dementia patients. To rule out this possibility, doctors may question patients about their mood and sense of well-being. Moreover, they may also ask questions about patterns of concerning behaviour.
Known genetic defects cause some variations of dementia. Doing a genetic test can help confirm if a patient does in fact have these types of dementia or identify people at risk for dementia.
What comes next after a diagnosis? The doctor would most likely discuss a treatment plan with the patient. Subsequently, patients are also provided with an overview of the available treatment options along with potential benefits and drawbacks.
Although dementia does not have a cure, therapy and medication can help manage symptoms. To illustrate, a paper published in
Therapeutic Advances in Neurological Disorders indicated that currently, available treatment demonstrates consistent benefits for cognition and functionality of patients. Nevertheless, they can not slow down the progression of the condition.
Most available drugs target Alzheimer’s disease because it’s the most common cause of dementia. Cholinesterase inhibitors and memantine (Namenda) are two types of drugs that medical health professionals often prescribe for dementia patients.
- Cholinesterase inhibitors: Eg; donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). These drugs boost the levels of a brain chemical involved in memory and judgment. Moreover, Cholinesterase inhibitors are not limited to the treatment of Alzheimer’s disease. Patient’s who have vascular dementia, dementia with Lewy bodies, and Parkinson’s disease dementia can also benefit from them.
- Memantine (Namenda): Memantine regulates the activity levels of Glutamate, which is a brain chemical messenger involved in learning and memory. They are sometimes prescribed in combination with Cholinesterase inhibitors.
Medication to treat related conditions
With the progression of dementia, patients often develop a range of other behavioral and psychological symptoms. For instance, anxiety, aggression, and hallucinations. These kinds of behavior can be distressing to both the patient and their caregivers. Accordingly, antipsychotic medicines such as risperidone or haloperidol may be prescribed.
Therapeutic treatment for dementia
Medication is just one part of the treatment. Oftentimes, patients receive medication along with therapy which can help support them to lead a more functional life. Some of these interventions include,
- Cognitive stimulation therapy: these are group therapy sessions led by an occupational therapist or a trained nurse. Sessions usually have a theme and consist of activities and exercises designed to improve memory and problem-solving skills. For instance, following a recipe and measuring ingredients to bake or cook something. Activities are often fun, sociable, and relaxed. However, they are only useful for patients with mild to moderate dementia.
- Cognitive rehabilitation: a therapeutic intervention that can help make managing everyday activities easier for people in their early stages of dementia. Usually, the occupational therapist directing this process will assist the patient in achieving certain goals such as learning to use a computer or a normal day-to-day activity. Cognitive rehabilitation allows patients to use the healthy areas of their brains to help the faulty areas.
- Life story work and reminiscence: Both these approaches are designed to boost patient mood and sense of well-being. Let’s take a look at the process. Reminiscence work, as its name suggests, involves talking about a patient’s past and good memories. To do this, they are presented with old pictures or favorite possessions. On the other hand, a life story work approach is done by asking a patient to create a compilation of notes, pictures, and childhood keepsakes.
The future is bright
By now when you think about dementia the first three words that come to your mind are probably “complicated, incurable, and debilitating”. These are all true. However, let’s look at the bright side of things. Dementia research has now become a major part of the medical world. Research funding has seen a significant increase, and many pharmaceutical companies are competing to introduce new cutting-edge dementia treatment interventions. Currently, researchers believe that an effective treatment or even a complete cure could be available in the next 10 years. This is big news!
Recent developments in research
Here is some more good news.
- In 2019 researcher’s developed a new blood test to diagnose Alzheimer’s disease. The test is supposedly around 94% effective and can detect the disease much earlier than brain scans would.
- A new drug with the name Aduhelm (aducanumab) was introduced in Autumn 2019 for the treatment of Alzheimer’s. Its clinical trials indicated that the drug can slow down the progression of the disease. Recently the drug received approval from the FDA and is now available to the public.
A final note
Please reach out to us, if you are currently living in Australia and want to get yourself, or a loved one tested for dementia. Here at Epsychiatry, we have trained and well-experienced psychiatrists and psychologists who are always available to help you with the testing process. You can learn more about our doctors and psychologists through the “about us” section of our website.