What You Need To Do

Schedule an appointment with the Primary Care Physician

Seeking out medical assistance can allow a physician to rule out treatable conditions from that of dementia, since, treatable conditions often display dementia-like symptoms.  Thus, a thorough medical, psychological, and social examination will allow the patient to rule out a diagnosis of dementia with reasonable accuracy.  Also, it is very important for a family member to accompany the patient to the primary care physician appointment.

Patient's Medical History

Provide the primary care physician with information regarding the patient's cognitive impairments, general everyday health, difficulty in performing routine activities, level of support given to patient at home, current medical equipment patient utilizes for mobilization, recent driving record, and any personality /mood changes or wake/sleep cycle.  Update the primary care physician of any medication changes, diet and eating pattern, illness or increased fatigue, outcome of specialty physician appointments, substance abuse history, and recent hospitalizations.  The primary care physician will take all this information into consideration when trying to rule out dementia as the primary diagnosis.

Basic Medical Tests

The primary medical physician will conduct diagnostic tests, such as: blood tests, thyroid and liver function tests, glucose tests, etc., to look for infections, malnutrition, dehydration, pain, anemia, vitamin deficiencies, excess consumption of alcohol, side effects of medication, diabetes, kidney or liver disease, thyroid abnormalities, problems with the heart, lung or blood vessels, etc., in order to rule out medical illnesses.

Neurological Exam

This important exam assesses the proper functioning of the patient's nervous system, as a whole, but focuses primarily on the brain and attempts to identify disorders. This specialist physician, a neurologist, will conduct MRI, CT, PET, and EEG scans, such as:

Brain Imaging: Identifies changes in brain structure and functions in order to identify strokes and tumors.

Structural Imaging: Identifies changes in brain shape, position, and volume of brain tissue.

Functional Imaging: Identifies oxygen and sugar metabolism in brain cells.

Electroencephalogram:  Identifies electrical activity and abnormalities by placing electrodes at various places over the scalp and recording electrical impulses of the brain.

The Neurologist may conduct test for reflexes, coordination and balance, muscle tone and strength, eye movement, speech and sensation.

Geriatric Psychiatric and Psychological Evaluation

A geriatric psychiatrist (a physician specializing in geriatric medicine) works with a psychologist (a clinician specializing in mood and cognitive disorders) to rule out any personality (mood or behavioral) changes, wake/sleep patterns, and cognitive changes.  Tests often used, in conjunction with a neurological exam are:

Geriatric Depression Scale (GDS) Assessment of patient's level of sadness based upon 60 questions, with a score of 6 + indicating depression.

Mini-Mental State Exam (MMSE) Assessment of patient orientation, recollection, calculation, retention, and language skills based upon 30 questions, with 20-24 score indicating mild cognitive impairment, 13-20 indicating moderate cognitive impairment, and less than 12 indicating severe cognitive impairment.

Medication Options

Medications prescribed to help minimize early symptoms of dementia include:

Aricept (Donepezil), Exelon (Rivastigmine), Reminyl (Galantamine):  These medications have been proven to delay the progression of dementia for about one year in patient's experiencing mild cognitive impairments.

Namenda (Memantine Hcl) This medication was initially prescribed for patient's experiencing moderate to severe cognitive impairments, but is now prescribed for patient's experiencing mild cognitive impairments.

Cholinesterase inhibitors are used to treat cognitive functions and behavioral symptoms in Lewy Body Disease. 

Vitamin E

Risperdal (Risperidone), Zyprexa (Olanzapine), Seroquel (Quetiapine), Zeldox (Ziprasadone), Geodon, and (Haloperidol) are antipsychotic medications sometimes used to treat personality (mood and behavioral) changes, such as : verbal angry outbursts and physical aggression toward caregivers, often associated with moderate to severe cognitive impairments. 

It is important to note that medication come with side effects and complications to other medications and/or disease processes.  Common side effects of some (but not all) of the medication listed above include sedation, increased confusion, agitation, dizziness, delusional behavior, increased muscle rigidity, decreased alertness, and drooling.