Initially, a neurological evaluation should be conducted to confirm that memory problems are not being caused by an easily fixed problem.
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Before a referral to a neurologist, your primary care doctor should have run blood tests for thyroid function, kidney and liver health, anemia, and vitamin deficiencies (especially some of the B-vitamins).
The primary care provider may also have asked about
- chronic pain,
- and sleep disturbances.
There are no “absolutely 100% positives” for Alzheimer’s Disease or any of the other other dementias.
A good neurologist, however, can assemble a strong case for a particular diagnosis using information from
- a comprehensive neurological examination,
- a detailed family and personal history,
- and brain imaging (usually magnetic resonance, aka MRI).
For example, early onset Alzheimer’s Dementia, frontotemporal dementia, vascular dementia, and even Lewy Body Dementia can look somewhat the same at the beginning. However, all have unique features that can be teased out based on detailed questioning and a comprehensive neurological examination.
If the person has had strokes or a history of high blood pressure or heart attacks, the memory problems are caused by vascular dementia.
If the family member reports that the person “acts out” her dreams, the suspicion for Lewy Body Dementia grows.
Has the person’s personality undergone a serious change? If yes, frontotemporal dementia may be something to consider.
An MRI may be ordered to see if there are other physical reasons for changes in memory; it also pinpoints areas of the brain that are shrinking, or “atrophying.”
Although the science is not exact, we have a great deal more information on patterns of atrophy corresponding to specific types of dementia now than we did 10 years ago.
For example, a common pattern of atrophy seen with early Alzheimer’s Dementia is shrinkage of the hippocampi (2 curvy areas deep inside the brain that form the limbic system) plus generalized brain shrinkage.
If the front and sides of the brain are shrinking, then frontotemporal dementia is suspected.
Sometimes, a person may have two types of dementia occurring at the same time, or one happening on top of another one.
Having a diagnosis can help with medication decisions.
Donepezil (Aricept) is FDA approved for Alzheimer’s Dementia while its relative, rivastigmine (Exelon) is FDA approved for Parkinson’s Disease Dementia.
These medications can slow down the symptoms but not the death of the cells.
And, as the different parts of the brain shrink, the behaviors that caregivers face (such as repeated questions, refusals to take a bath, wandering, shadowing, sleep/wake disturbances) often surface.
Next time I will write about - When Do We Stop Seeing the Neurologist?
You can contact or ask Dr. Jablonski-Jaudon a question at email@example.com
Rita Jablonski-Jaudon, PhD, CRNP, FAAN is an internationally recognized researcher and expert on non-drug ways to handle dementia-related behaviors. She is an Associate Professor at the School of Nursing at the University of Alabama at Birmingham and a nurse practitioner in The Memory Disorders Clinic at the Kirklin Clinic, UABMC, Birmingham, Alabama.
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