Evaluation Of Dementia Persons

October 1, 2007

Persons who develop symptoms of dementia should undergo a medical evaluation for treatable causes. Even if a treatable form of dementia is not found, it is advantageous to establish a diagnosis because this makes it possible to predict the course of the particular illness.

The evaluation begins with a history of the illness and is usually obtained from a family member or close friend since the demented individual is no longer capable of providing accurate information. For diagnostic purposes the physician will be very interested to know when symptoms began to occur certain diseases, such as Alzheimer’s disease, have a slow and insidious onset. Rarely is it possible for the family member to date precisely the beginning of this dementing illness. In contrast, symptoms may have arisen quite suddenly if the patient has a disorder such as liver failure, kidney failure, or drug overdose.

The course of the dementing illness, or the rate at which symptoms become more severe, is also meaningful. In the case of Alzheimer’s disease, the course is invariably slow and progressive. Alzheimer’s disease will usually progress for several years prior to becoming severe enough that the family will seek medical attention. The victim may in the early stages have a tacit awareness that something is amiss, although frequently the affected person is without any appreciation of these potential problems. So-called multi-infarct dementia is caused by serial strokes. Unlike Alzheimer’s disease, this form of dementia presents a pattern of step-by-step progression punctuated by the occurrence of multiple strokes. In between the strokes victims may actually improve slightly.

The history of fluctuations in alertness is also helpful. The Alzheimer victim will normally have an alert level of consciousness. In contrast, persons suffering from liver failure, kidney failure, drug overdosage, blood clots on the brain (subdural hematomas), electrolyte imbalance, or infections of the nervous system will typically have fluctuating periods of alertness and sleepiness.

In addition to a medical history, both general and neurological examinations should be performed. Their purpose is to find impairment of organ systems or evidence of localized brain disease. For example, the physician may find evidence of liver or kidney failure (fluctuating level of consciousness, flapping type of tremor of outstretched hands, and unusual odor). The physician may also find evidence of localized disease.

Posted in Medical Aspects