Bob DeMarco Alzheimer's Reading Room

Monday, September 14, 2009

When the Doctor Says its Dementia or Alzheimer's Without a Test


I just finished reading an article on the Orlando Sentinel that disturbed me--Get tests before accepting any diagnosis of dementia.

A reader wrote in to the Orlando Sentinel asking for advice--asking this question.
My mother and father are in their early 80s. Both are both hard of hearing and refuse to wear hearing aids. It seemed to the family — including Dad — that Mom's memory was slipping intermittently. So, to make sure we stayed on top of things, we took her to her longtime family doctor.

After talking to her, Dad and me for about 10 minutes, but without giving her any testing, he concluded she had at least mild dementia and prescribed a medication for her that he said might work.


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The person(s) who submitted the question then went on to say,
But it has done absolutely no good over the past six weeks (the medication). She has had indigestion, headaches and generally feels bad. Upon calling her physician, he took her off the medicine and told us to let the condition run its natural course.
The Sentinel authors then responded with this information,
Based on the description you give, it appears that your mother's doctor jumped to the diagnosis of "dementia" prematurely, especially since no tests were conducted. Generally, if a patient is confused or disoriented, a test called the Mini Mental Status Examination (MMSE) is given to try to ascertain the patient's level of cognition. Apparently, however, your mother's physician did not conduct this test.
The authors then go into a long explanation of how dementia is often misdiagnosed, and a list of things it could be other than dementia.

I understand that the authors for the Orlando Sentinel are good intentioned, but they really didn't provide much help. They did not provide a specific answer to the question--what to do.

It seemed to me that issue number one is the doctor. I'm sure the doctor is well intentioned. However, it should be clear that he is not well educated in the diagnosis of dementia. It should also be clear that he is either detached from reality, or just doesn't understand what happens to a family and a caregiver when dementia strikes.

Here is what the doctor did and said when the medication caused complications and didn't seem to be working.
...he took her off the medicine and told us to let the condition run its natural course.
Most people would accept this and let the problem fester. However, if it is dementia the patient (the mother) is going to start evidencing all kinds of behaviors that come with dementia. She is going to get worse.

A second issue that I am now becoming familiar with is the problem of living in a small town. Small town, no where to turn, what to do?

Here is what I would suggest.

  • Dial 211 (www.211.org). It is like dialing 911 on your telephone.2-1-1 provides free and confidential information and referral. Call 2-1-1 for help with food, housing, employment, health care, counseling and more. 
  • Call the Alzheimer's Association Helpline--800-272-.3900. 
  • Try to find the closest Senior Center and ask for a social worker. 
  • If there is a University in the area--call and see if they have a Wellness Center, or a group doing dementia or Alzheimer's research.
At the minimum demand that the doctor refer your loved on to a neurologist. If he refuses contact the healthcare insurance provider, and file a complaint with all the information, including the initial diagnosis. The complaint will get the ball moving.

Reader are encouraged to offer suggestions on what to do when you live in a small town and find yourself in a similar situation.

Also see
Is it really Alzheimer's or something else?

Doctors not Good at Detecting Alzheimer's and Dementia

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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,640 articles with more than 11,000 links on the Internet. Bob resides in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room