Diagnosis of Alzheimer’s Disease

Strategy: Obtaining a Proper Diagnosis

Memory problems could be caused by Alzheimer’s disease or other medical conditions, so it is important to obtain a proper diagnosis. Some memory problems can be readily treated, such as those caused by vitamin deficiencies or thyroid problems. Other memory problems might result from causes that are not currently reversible, such as Alzheimer’s disease.

  • Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes.
  • Clinicians diagnose “probable” Alzheimer's disease by doing a thorough diagnostic work-up. This can include a complete medical history; physical examination to find evidence of any underlying medical or neurological disorders that may be contributing to symptoms; neuropsychological tests that gauge memory, attention, language skills and problem-solving abilities; laboratory tests that can include blood and urine samples; and brain imaging scans, such as a CT scan, MRI, SPECT or PET scan, which can identify changes in brain structure or activity.
  • For Medicare beneficiaries, a new annual wellness visit (AWV) includes “detection of any cognitive impairment” as well as personalized prevention plan services. A health provider will assess cognitive impairment by direct observation and consideration of information obtained from patient reports and concerns raised by family members, friends, caregivers or others. This provision, part of the new healthcare reform law, took effect January 1, 2011.
  • A beneficiary is entitled to an AWV by a primary care provider or other health provider after having Medicare Part B coverage for at least 12 months and not having an AWV or the “Welcome to Medicare Visit” initial preventative physical exam within the past 12 months. There is no coinsurance or deductibles for the AWV.
  • The causes of dementia are complex; a complete clinical evaluation by a skilled clinician will identify the primary cause of dementia in more than 90 percent of cases.
  • Clinicians diagnose Alzheimer’s disease as the cause of dementia in about 60 percent of individuals living with the disease.
  • Alzheimer's disease is characterized by two types of abnormal lesions in the brain: Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons; and neurofibrillary tangles—insoluble twisted fibers composed largely of the protein tau that build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are unclear whether they cause it or a byproduct of it

Strategy: Asking Questions

Open communication with your loved one’s health care professional and asking questions can help toward understanding a diagnosis and next steps, including treatment options and support.

  • What is the diagnosis?
  • What other tests should be taken?
  • Should we see a neurologist, geriatrician or other specialist?
  • How does the disease progress (symptoms, time span)?
  • What are all the available treatment options?
  • What is the effectiveness of each medication, in terms of memory, behavior and other symptoms?
  • What are the side effects, dosage, possible drug interactions, and pros and cons of each treatment?
  • What changes in condition should we report to you?
  • In addition to medication, what do you recommend in terms of diet, vitamins, physical exercise, mental activities and other lifestyle changes?
  • Are there any clinical drug trials that would be appropriate to participate in? What are the risks and benefits?
  • What advice can you provide regarding care?
  • Do you have information about community resources, such as support groups, educational workshops and services for my family?
  • Will you be speaking with my loved one's other doctors?
  • How often should we make an appointment to see you?

FAQ (to AFA’s social services team)

FAQ: Discussing the Diagnosis

Q. What can I do about the fact that my loved one is in denial about his diagnosis of Alzheimer’s disease?

A. When faced with a diagnosis of dementia, many persons—both individuals with the disease and family
members—experience denial. Denial has served human beings as a useful protective mechanism.

It can be life-shattering when people obtain a diagnosis of dementia, especially in the earlier stages when they better understand what is happening. Their greatest fears are materializing. As a result, there could be a grief reaction—a trauma-like state that occurs in response to the losses they are facing. When it becomes too difficult to admit to those losses, denial sets in. It is far easier to say, “There is nothing wrong with me,” than to actually admit the truth.

What makes this tricky is that people with dementia may no longer have the proper coping mechanisms to appropriately process the grief—to work through the denial and accept the situation. Living in denial can obstruct the ability to recognize problems and interfere with their ability to successfully manage daily living activities, self-care and independent living.

Sometimes, denial can end when a person has collected overwhelming evidence for the truth—often as a result of worsening conditions or when the person is talked through it by a skilled therapist, an authority such as a doctor, or a chorus of relatives. Continue the discussion at home, but gently and with loving assertion. If your loved one reads, share selected material about the disease and use videos to reinforce points you are making. Always reassure him that you will take care of him.

There is no guarantee that he will understand or accept his new condition. However, the potential rewards make it worth trying. If he does come to accept his illness, he may also accept your gifts of help, participate in planning about future care, financial issues and other concerns, and will be more likely to experience contentment in daily routines.

There is another scenario as well. Depending on how far along people are in the disease process, it might be impossible to grasp the fact that they have Alzheimer’s disease. Since one of the first regions of the brain to be damaged by Alzheimer’s disease is the portion that affects short-term memory function, people with the illness are not capable of remembering that they have been repetitious or confused lately.

Therefore, they may not have any recall about a diagnosis of Alzheimer’s disease no matter how many times you say it. In fact, each reminder may only set the stage for an argument—or more anger. Trying to convince them that they have dementia and need help tends to backfire since their limited judgment and reasoning skills interfere with rational thinking

While self-awareness can be useful—for example, giving a caregiver a basis for discussion about the individual’s long-term care wishes, and legal and financial planning—ultimately, convincing someone that he or she has Alzheimer’s disease may not be so important.

FAQ: Anger

Q. Does someone with Alzheimer’s disease ever stop being angry at you?

A. It helps to understand what people with Alzheimer’s disease are going through. They are living each moment with a sense of uncertainty regarding where they should be and what they should be doing. The world around them seems confusing and distorted, and they are trying to make sense of things with only tiny bits and pieces of information.

To complicate matters further, the damage done to the brain by Alzheimer’s disease affects a person’s ability to control moods. Anger is only one example of this loss of control; people with dementia may laugh during a serious moment or cry without cause. The frustration of this lifestyle must be terribly difficult. Therefore, it is actually quite understandable that people with Alzheimer’s disease are often angry. So, as you can see, this anger is not intentional.

What your loved one needs most from you and others is understanding. Kindness and patience are the solutions. The way you behave can serve to have a calming influence on your loved one. With a parent, it especially helps to use memories of what your mom or dad has done to help you through difficult times to feel empowered.