What are the potential benefits of a timely diagnosis of dementia?
Early diagnosis of dementia is important as:
1. Memory loss and confusion can be caused by several different diseases, some of which are treatable and reversible. e.g., thyroid disease, infections, depression
2. Early treatment has the greatest potential to improve long term outcomes- to slow down cognitive decline and maintain function at the highest level as long as possible.
3. Early diagnosis may help lessen anxieties about why you or your loved ones are experiencing symptoms.
4. Appropriate care can improve quality of life for patients & carers.
5. It can help people with dementia to have access to relevant information, resources and support.
6. It allows you to express your wishes about legal, financial and end-of-life decisions and plan for the future.
What are your main barriers to a timely diagnosis of dementia?
Diagnosis of dementia is often delayed. It is estimated that about 50 percent of patients aged over 65 years with dementia are not diagnosed. Most patients have reached moderate stages by the time the diagnosis is made. There are several factors potentially contributing to the delay in the diagnosis in dementia:
1. There is general lack of awareness and understanding among patients and families about dementia, which is largely responsible.
2. Sometimes memory problems are overlooked as part of the normal ageing process.
3. Patients, families, and physicians seem reluctant to recognize and to diagnose dementia—a serious, progressive condition without a cure, which continues to be associated with stigma.
4. A nihilistic attitude (the belief that ‘‘nothing can help’’) to treatment of dementia appears to exist, although evidence suggests that this may be on the decline.
What are the signs of dementia?
1. Memory loss / forgetfulness – Memory loss that disrupts daily life may be a symptom of dementia. People with dementia may forget where they kept their belongings and struggle to find them or misplace them. They may forget important conversations and sometimes repeat them. They may forget familiar names, important events such as birthdays, important appointments, and to take their medications.
2. Confusion – As the disease gets worse people with dementia may get confused about days and times. They can get confused about where they are and sometimes be unable to recognise their familiar surroundings (sometimes their own home). Some people may get more confused towards the evening (sundowning) or when they are tired.
3. Difficulty with planning - A person with dementia may experience problems with starting, organizing, planning, or completing tasks. They may struggle to manage time well and encounter difficulty in meeting deadlines or goals and determining the amount of time that has passed or is necessary to complete a task.
4. Difficulty with directions- People with dementia may have trouble with directions and may get lost in familiar places such as shopping malls. They may experience navigation difficulties while driving on familiar roads. Dementia can make it hard to judge distances and to pay divided attention for example when arriving a roundabout.
5. Language problems- A person with dementia may experience trouble finding the right words. Sometimes they may substitute inappropriate words that can make sentences difficult to understand. They may experience a decline in proper spelling, punctuation and grammar, and develop handwriting that is difficult to read. In some types of dementia such as primary progressive aphasia language is affected early in the disease.
6. Difficulty performing familiar tasks- As the illness continues to progress, performing everyday tasks becomes more difficult. This refers to tasks regularly done at home or at work, such as operating appliances or the computer, cooking or shopping.
7. Loss of initiative-This is also known as apathy and is a common symptom of dementia. A person with dementia they may show signs of reduced initiative or lose interest in activities they previously always enjoyed.
8. Behavioural or personality changes- Behavioural changes may include agitation, verbal or physical aggression, and wandering. People with dementia can develop personality changes, such as acting inappropriately, being disinhibited or changing from being outgoing to very withdrawn.
9. Mood changes- Both anxiety and depression are very common symptoms in early or prodromal stages of dementia.
10. Psychotic symptoms- Sometimes people with dementia can develop hallucinations, for example, they may see strangers, small children or animals inside their home or in the yard. Sometimes they can become suspicious (paranoid) – they can suspect family members are stealing from them, people are watching them, or strangers are going to break into their home.
How can a geriatrician help?
If these symptoms apply to you (or your loved one), we recommend talking to your doctor for support and guidance. Your doctor may consider referring you to a local geriatrician. A geriatrician can perform a clinical assessment, order investigations and determine the underlying cause, recommend treatment to ease symptoms and slow the progression of the disease, and improve patient’s overall quality of life.