“Doctor, do you diagnose dementia? Because I need someone who can diagnose dementia.”
A man asked me this question recently. He explained that his 86 year-old father, who lived in the Bay Area, had recently been widowed. Since then the father had sold his long-time home rather quickly, and was hardly returning his son’s calls.
The son wanted to know if I could make a housecall. Specifically, he wanted to know if his father has dementia, such as Alzheimer’s disease.
This is a reasonable concern to have, given the circumstances.
However, it’s not very likely that I — or any clinician — will be able to definitely diagnose dementia based a single in-person visit.
But I get this kind of request fairly frequently. So in this post I want to share what I often find myself explaining to families: the basics of clinical dementia diagnosis, what kind of information I’ll need to obtain, and how long the process can take.
Now, note that this post is not about the comprehensive approach used in multi-disciplinary memory clinics. Those clinics have extra time and staff, and are designed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cognitive problems in people who are relatively young.
Instead, in this post I’ll be describing the pragmatic approach that I use in my clinical practice. It is adapted to real-world constraints, meaning it can be used in a primary care setting. (Although like many aspects of geriatrics, it’s challenging to fit this into a 15 minute visit.)
Does this older person have dementia, such as Alzheimer’s disease? To understand how I go about answering the question, let’s start by reviewing the basics of what it means to have dementia.
5 Key Features of Dementia
A person having dementia means that all five of the following statements are true:
- A person is having difficulty with one or more types of mental function. Although it’s common for memory to be affected, other parts of thinking function can be impaired. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) lists these six types of cognitive function to consider: learning and memory, language, executive function, complex attention, perceptual-motor function, social cognition.
- The difficulties are a decline from the person’s prior level of ability. These can’t be lifelong problems with reading or math or even social graces. These problems should represent a change, compared to the person’s usual abilities as an adult.
- The problems are bad enough to impair daily life function. It’s not enough for a person to have an abnormal result on an office-based cognitive test. The problems also have to be substantial enough to affect how the person manages usual life, such as work and family responsibilities.
- The problems are not due to a reversible condition, such as delirium, or another reversible illness. Common conditions that can cause — or worsen — dementia-like symptoms include hypothyroidism, depression, and medication side-effects.
- The problems aren’t better accounted for by another mental disorder, such as depression or schizophrenia.
Dementia — now technically known as “major neurocognitive disorder” — is a syndrome, or “umbrella” term; it’s not considered a specific disease. Rather, the term dementia refers to this collection of features, which is caused by some form of underlying damage or deterioration of the brain.
Alzheimer’s disease is the most common underlying cause of dementia. Vascular dementia (damage from strokes, which can be quite small) is also common, as is having two or more underlying causes for dementia. For more on conditions that can cause dementia, see here.
What Doctors Need to Do To Diagnose Dementia
Now that we reviewed the five key features of dementia, let’s talk about how I — or another doctor — might go about checking for these.
Basically, for each feature, the doctor needs to evaluate, and document what she finds.
1. Difficulty with mental functions. To evaluate this, it’s best to combine an office-based cognitive test with documentation of real-world problems, as reported by the patient and by knowledgeable observers (e.g family, friends, assisted-living facility staff, etc.)
For cognitive testing, I generally use the Mini-Cog, or the MOCA. The MOCA provides more information but it takes more time, and many older adults are either unwilling or unable to go through the whole test.
Completing office-based tests is important because it’s a standardized way to document cognitive abilities. But the results don’t tell the doctor much about what’s going on in the person’s actual life.
So I always ask patients to tell me if they’ve noticed any trouble with memory or thinking. I also try to get information from family members about any of the eight behaviors that are common in Alzheimer’s. Lastly, I make note of whether there seem to be any problems managing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
2. Decline from previous level of ability. This feature can be hard for me to detect on my own during a single visit. To document a decline in abilities, a doctor can interview other people, and/or document that she’s reviewed previous cognitive assessments. I have also occasionally documented that a patient is currently unable to correctly perform a cognitive task that is related to her career or education history. For instance, if a former accountant can no longer manage basic arithmetic, it’s reasonable to assume this reflects a decline from previous abilities.
3. Impairment of daily life function. This is another feature that can be tricky to detect during a single visit, unless the patient is very impaired. I usually start by finding out what kinds of ADLs and IADLs help the person is getting, and what kinds of problems have been noted. This often means talking to at least a few people who know the patient.
Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first.
In some cases — usually very early dementia — it can be quite hard to decide whether a person’s struggles have become enough to qualify as “impairment of daily life function.” If someone isn’t taking his medication, is that just regular forgetfulness? Ambivalent feelings about the medication? Or actual impairment due to brain changes? If I’m not sure, then I may document that the situation seems to be borderline, when it comes to impairment of daily life function.
4. Checking for reversible causes of cognitive impairment. I mentally divide this step into two parts. First, I consider the possibility of delirium, a very common state of worse-than-usual mental function that’s often brought on by illness. For instance, I’ve noticed that older people are often mentally assessed during or after a hospitalization. But that’s not a good time to try to definitely diagnose dementia, because many elders develop delirium when they are sick, and it can take weeks or even months to return to their previous level of mental function.
(My approach to considering dementia in older adults who are confused during or after hospitalization: Make a note that they may have underlying dementia, and plan to follow-up once the brain has had a chance to recover.)
After considering delirium, I check to see if the patient might have another medical problem that interferes with thinking skills. Common medical disorders that can affect thinking include depression, thyroid problems, electrolyte imbalances, B12 deficiency, and medication side-effects. I also consider the possibility of substance abuse.
Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes additional evaluation. It may even involve doing an MRI of the brain. I’ve written an article with more details about this here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
If I do suspect delirium or another problem that might cause cognitive impairment, I don’t rule out dementia. That’s because it’s very common to have dementia along with another problem that’s making the thinking worse. But I do plan to reassess the person’s thinking at a later date.
5. Checking for other mental disorders. This step can be a challenge. Depression is the most common mental health problem that makes dementia diagnosis difficult. This is because depression is not uncommon in older adults, and it can cause symptoms similar to those of dementia (such as apathy, and poor attention). We also know that it’s quite common for people to have both dementia and depression at the same time.
In many cases, there may be no easy way to determine whether an older person’s symptoms are depression, early dementia, or both. So sometimes we end up trying a course of depression treatment, and seeing how the symptoms evolve over time.
It’s also important to consider the older person’s mental health history. Paranoia and delusions are quite common in early dementia, but could be related to a mental health condition associated with psychosis, such as schizophrenia.
Is it Alzheimer’s Disease or another form of Dementia?
Families often want to know just what type of dementia their loved one has. Is the underlying condition Alzheimer’s disease? Lewy-body disease? Vascular dementia? Or frontotemporal?
The truth is that as people get into their 80s, the answer is that usually it’s “mixed dementia,” meaning that if we were to look inside the brain, we would find two or more causes of damage to brain cells.
This has been a consistent finding in brain studies of older adults with dementia, with one autopsy study finding that 78% of participants had 2+ causes, and a whopping 58% had 3+ causes. This study found that Alzheimer’s disease was very common (present in 65% of participants), but was rarely the only underlying cause of dementia.
In other words, especially in people aged 85+, the symptoms that families observe are probably a mix of two or more dementia causes.
Furthermore, in geriatrics, we find that the likely type of dementia does not help us manage symptoms and care. Most medications that are FDA-approved for dementia can be used for the various types (and none works very well). Generally, the best way to provide care is to focus specifically on whatever symptoms or difficulties the person with dementia is experiencing.
That said, it’s true that in recent years, researchers have been able to identify “biomarkers” to help identify certain dementia causes in the brain.
This is especially true for Alzheimer’s disease, which starts affecting the brain an estimated 15 years prior to obvious symptoms. Signs of “pre-clinical” and very early Alzheimer’s disease can be detected through special brain scans, and through analysis of the cerebral spinal fluid.
However, this type of biomarker assessment is mostly used in special research studies, and is not yet available for routine clinical care. It’s also mostly used in research evaluations of middle-aged adults and the “young-old” (e.g. people under age 75).
Is it Dementia or Mild Cognitive Impairment?
Sometimes, when an older person is having memory problems or other cognitive issues, they end up diagnosed with “mild cognitive impairment.”
Mild cognitive impairment (MCI) means that a person’s memory or thinking abilities are worse than expected for their age (this should be confirmed through office-based cognitive testing), but are not bad enough to impair daily life function.
The initial evaluations for MCI and dementia are basically the same: doctors need to do a preliminary office-based cognitive evaluation, ask about ADLs and IADLs, look for potential medical and psychiatric problems that might be affecting brain function, check for medications that affect cognition, and so forth.
I explain more about MCI in this article: How to Diagnose & Treat Mild Cognitive Impairment.
But remember: in practical terms, if an older person’s memory problems have gotten bad enough that he can’t grocery shop the way he used to, or she can no longer manage her finances on her own…those qualify as impairment in daily life function. And so, a diagnosis of “mild cognitive impairment” is probably not appropriate for those cases.
To learn more about the difference between mild cognitive impairment, Alzheimers and dementia, watch this video:
Can Dementia Be Diagnosed During a Single Visit?
So can dementia be diagnosed during a single visit? As you can see from above, it depends on how much information is easily available at that visit. It also depends on the symptoms and circumstances of the older adult being evaluated.
Memory clinics are more likely to provide a diagnosis during the visit, or shortly afterwards. That’s because they usually request a lot of relevant medical information ahead of time, send the patient for tests if needed, and interview the patient and a family member (or other knowledgeable “informant”) extensively during the visit.
But in the primary care setting, and in my own geriatric consultations, I find that clinicians need more than one visit to diagnose dementia or probable dementia. That’s because we usually need to order tests, request past medical records for review, and gather more information from the people who know the older person being evaluated. It’s a bit like a detective’s investigation!
Can Dementia be Inappropriately Diagnosed in a Single Visit?
Sadly, yes. Although it’s common for doctors to never diagnose dementia at all in people who have it, I have also come across several instances of busy doctors rattling off a dementia diagnosis, without adequately documenting how they reached this conclusion. (It’s also common for them to hardly document anything in terms of the older peron’s cognitive state, other than “confused, didn’t know date.”)
Now, often these doctors are right. Dementia becomes common as people age, so if a family complains of memory problems and paranoia in an 89 year old, chances are quite high (at least 60%, according to UpToDate) that the older person has dementia.
But sometimes it’s not. Sometimes it’s slowly resolving delirium along with a brain-clouding medication. Sometimes it’s depression.
It is a major thing to diagnose someone with dementia. So although it’s not possible for an average doctor to evaluate as thoroughly as the memory clinic does, it’s important to document consideration of the five essential features of dementia that I listed above.
If You’re Worried About Possible Alzheimer’s or Dementia
Let’s say you’re like the man I spoke to recently, and you’re worried that an older parent might have dementia. (Remember, most dementia is due to Alzheimer’s or a similar underlying brain condition.) You’re planning to have a doctor assess your parent. Here’s how you can help the process along:
- Obtain copies of your parent’s medical information, so you can bring them to the dementia evaluation visit. The most useful information to bring is laboratory results and any imaging of the brain, such as CAT scans or MRIs. See this post for a longer list of medical information that is very helpful to bring to a new doctor.
- Write down worrisome behaviors and problems, and bring this documentation to the visit. You can start with this list of 8 behaviors to track if you’re concerned about Alzheimer’s.
- Consider who else might know how your parent has been doing and behaving recently: other family members? Close friends? Staff at the assisted-living facility? Ask them to share their observations with you and jot down what they tell you. Share these notes, along with the names of the informants, with your parent’s doctor.
- Be prepared to explain how your parent’s abilities have changed from before.
- Be prepared to explain how your parent is struggling to manage daily life tasks, such as work, house chores, shopping, driving, or any other ADLs and IADLs.
- Bring information about any recent hospitalizations or illnesses.
- Bring information about any history of depression, depressive symptoms, or other mental illness history.
By understanding what it takes to diagnose dementia, and by doing a little advance preparation when possible, you will improve your chances of getting the evaluation you need, in a timely fashion.
Watch this Youtube video to learn six ways getting evaluated for memory loss benefits an older person and their family:
And if you have an aging parent who is refusing to get evaluated for memory loss or other concerning symptoms: my free online training for families (see below) covers how to get past this, and includes a nifty PDF summarizing what to say and not say to your parent who may have dementia.
This article was first published in 2015, and was last updated by Dr. K in September 2023.
Sherree D Pipps says
My brother is 67 years old. in August of this year he went into the hospital for back pain. After many week sof test & not knowing the dr.’s finally found that he has a staff infection in his spine. This turned into an abscess. He slowly lost the use of his legs. He also became confused, he was treated with medication 7 his confusion cleared up. He has been on antibiotics to clear up the infection for 8 weeks. They took him for an MRI to check on the infection & he came back confused. his confusion has gotten worse in the last 3 days. He know his name, birth dat, address, relatives names, the president, etc. he thinks his hospital bed is an airplane, he think his nurse is a model on the airplane, the thinks he is working on different things. He was fine 3 days ago with his mind then all of a sudden this. Not kidney trouble, MRI of the brain came back good, MRI of the spine came back that the infection is almost gone. We are at our wits end with what is goin on. The neurologist said that he seem to be getting better each day.
Nicole Didyk, MD says
I’m sorry to hear about all the difficulty your brother has had. It sounds like a very complicated hospital course.
Your description of what’s happening with the sudden and reversible episodes of confusion makes me think of delirium. Dr. K has an excellent article about delirium, which you can read here.. Delirium can happen in up to 30% of older adults admitted to hospital. It tends to fluctuate, so that people can seem fine one hour and very confused and drowsy the next. Hallucinations and misperceptions (like thinking the nurse is a flight attendant) are common with delirium too.
It’s a frightening condition, but it almost always gets better, although it can take days, weeks, or even longer to go away for good. Establishing a routine, encouraging someone to move around as much as possible, making sure he’s not dehydrated, and having the medical team review his medication list are all ways to prevent another episode of delirium from occurring. I made a video about this, which you can watch on YouTube here: https://www.youtube.com/watch?v=jtEBF6Jb6z8&t=145s
I hope everything goes well and your brother is home soon.
Stacey says
My 71yr old mum has had the initial test done at her GP (remembering list of 3 things, drawing something etc). Her GP seems to think she doesn’t have dementia but more memory loss due to living alone, depression & Covid lockdowns.
I get concerned when I am asked the same questions 4-5 times in a 40min phone conversation. I’m noticing slight changes in her abilities . Eg, a banana cake recipe she’s been baking for 20+ years, she’s had 3 failed bakes in the past 4 weeks.
Was always very good at sewing but these days seems to be mucking up simple things and having to start again or buy new material to try again.
I have already taken over her finances
Should I be sending her to a different GP or trying with a Geriatric specialist?
Should I be concerned?
Nicole Didyk, MD says
I can understand your mom’s doctor wanting to give her the benefit of the doubt after all of the social isolation and stress of COVID. Certainly, those issues could affect an older adult’s brain performance, even to the point where it gets in the way of some tasks like baking and sewing.
I’ve even made a video about distinguishing depression and dementia, which you can watch here: https://youtu.be/Me7c-vTshEk
If the depression and social isolation are treated, and the cognitive symptoms improve, it’s less likely that there’s a dementia. But if they don’t, or if the changes become more serious, I would seek another visit or a visit with another provider.
It sounds like you’re doing a great job of keeping tabs on your mom and the kinds of observations you’re making are exactly what a Geriatrician would ask about when doing an assessment. You’re right to be concerned and involved.
Rein Dekker says
I have been diagnosed with memory problems and retired a bit early from stressfull work with refugees in the Middle East. I used to take low dosage Stillnox / Diazepam to help me sleep better during those years. I now understand there may be a link between the use of this and the development of Dementia /
Alzheimers. Is that true and, if so, is there anything I can do about that now? Would appreciate any solid advice. Many thanks
Jody Glover says
My Dad just passed away, my 69yr old Mom has Rapid Cycling bipolar illness, she is putting a strain on me, she accuses me of wanting to kill her, I wanted to build an apartment in the basement she thinks I’m trying to shove her in a cave, she claims to be scared of me although I have never done anything, she seems to just hate me, she has attempted suicide multiple times and has blames me and I have been able to find NO SUPPORTS in my area. I’m unsure what to do, she doesn’t bathe, she smokes like a chimney, she’s on a plethora of medication and she smokes pot, she is becoming physically impaired, she slept at my house once and peed on my couch, she has 4 cats in a room that NEVER get out, she has 4 snakes in another room, I feel stuck and don’t know what to do??? PLEASE HELP,
Nicole Didyk, MD says
I’m so sorry that you lost your dad, and it sounds like you’re really having a struggle with your mother.
When serious mental illness is untreated, it can cause so much suffering for the person experiencing it and the family. If someone is a danger to themselves or others, because of self-neglect or risky behaviour, the police or social services could be called to assess the situation and decide if the person needs to go to hospital for an emergency evaluation. Short of that level of risk, though, it can be hard to force a person to make changes in their lifestyle. Sometimes we have to wait for a crisis for real change to happen. It’s just heartbreaking at times.
Dr. K has recently published a book called: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. This is a practical guide to how to start helping an aging parent, even when you don’t know where to start. You can learn more here. The book can help you to set small goals and make progress towards helping your mom.
Vicki Martin says
My sister (mom’s caregiver) has been telling me of my mom telling her of things I have never (or her) heard about before: My grandfather had a fake eye (we do not think this was true); best friends of my parents tried to kill them and told them they wanted them dead (again, not true to our knowledge). This especially comes out a lot where family (cousins of my mom) have tried to kill us and tried to kidnap us as babies. My mom only goes out for doctor’s appointments now…but it has been this way for years because one doctor told her she was allergic to everything and has no immune system. (This is before my dad passed away with Alzheimer’s 7 years ago). She really doesn’t like for us to visit because she is afraid we will bring something with us when we come to visit (8 hours away). Covid concerns have made it even worse. Is this just part of dementia or Alzheimer’s ? If so, it is so different than my dad’s declining years. The things she tells my sister (who passes them on to me to see if I knew of these things) seem so far-fetched and I really do not think they ever happened, too many to mention them all. Is there anything we can do?
Nicole Didyk, MD says
It must be distressing to hear these stories from your mom (through your sister). People living with dementia can express stories like the ones you describe, which are sometimes based on real occurrences, or could be a be a blend of facts and fiction. Dr. K has an article about other things that can cause these experiences aside from dementia, which you can read here.
If these stories are distressing to your mom, it may be something that medication or some other treatment could help, and a doctor can help sort this out. A primary care provider might need advice from a Geriatrician or psychiatrist if it’s complicated.
One thing to know is that arguing with your mom if you’re not sure if her stories are accurate is likely to lead to conflict, so ids best avoided. I made a video about that here: https://youtu.be/CA9EzGfS5jk
Cynthia Lee says
Went to my Moms to check on her this evening. We tried to get in the house but she had a table a microwave and few other items blocking the door. My sister stated this has happened before. It’s like she has a fear of someone coming in her house. I notice she is losing hearing. Today we buried her brother…let’s week we buried her nephew. She is the last living elder on our family side. My Mom is 77years old, she lives alone and still works as a CNA at the hospital. My and I are installing a Door Chime hoping that would at least make her feel better. We are concern and don’t know what to do or where to start. Our Mom is a person that will not tell you if something is wrong. And this Never been afraid of being ALONE ever.
Nicole Didyk, MD says
I’m so sorry to hear about your mom’s distress. It sounds like she has had some major stressors in her life with the loss of close family members, and sometimes that can be a trigger for a depression or other mood issues.
Dr. K has a great article on paranoid thoughts that might be helpful.
I agree with your idea about checking hearing. Hearing loss can be a barrier to communication and can worsen the symptoms of cognitive impairment.
Dr. K has a new book coming out very soon which is a guide to helping an older parent. You can find out more, here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
Dr. Kernisan’s Helping Older Parents Membership (betterhealthwhileaging.net)
It sounds like you’re working together as a family to help your mom and she’s so lucky to have you. I hope these suggestions are helpful.
Maggie says
My Dad is 63 and has been having memory loss and confusion. He went to a neurologist who believes he is suffering from dementia. He’s had bloodwork and a MRI that all have come back normal. I’m struggling to accept such a diagnosis at such a young age and so suddenly. He was also on a blood pressure medication that his PCP removed immediately after he complained of memory issues. Is this caused by his medication? Is is normal for symptoms to hit so young and suddenly?
Nicole Didyk, MD says
I can understand being shocked and struggling to understand this diagnosis.
Many factors can cause memory changes, including medications, alcohol use, mood disorders, stress, and other illnesses. A neurologist would probably be able to rule those other things out. Most blood pressure medications have few cognitive side effects, so it may have been a coincidence that the PCP stopped the medication. You would have to ask the doctor about that.
About 5-6% of all Alzheimer’s is early onset, that is, it comes on before the age of 65. I made a video about it, which you can watch here for more information. I would also advise contacting the Alzheimer’s Society in your area to get more info and support.
Annie says
I am upset. I brought my mother to the hospital because she is suffering of extreme knee pains. She has rhumatoid arthritis. Because her appointment with an orthopedist just canceled, and was prosponed in 6 weeks , it was best to call her doctor and ask to be admitted to the hospital. She was that much in pain.
What I am very concern is that after 4 days in the hospital trying to walk again, with prenizon, they did a cognitive test in an office …without telling me… some doctor called me, never talked about her physical treatment but rather said she will start medication for early sign of dementia, loosing her driving permit and going home the next day. Wow, with just 1 cognitive test? She did 21 but my mother is in pain, isolated in her home… yes her memory is not good but she manage her bank account,investment, call me every day, , and the only reason she told the doctors she was not able to do all task is because of pain but now the inflammation is gone but… dementia? Really? Taking her license? Never had an accident?
Please help …my mother is so angry and not able to go to church, grocery or breakfast with her friends by her own will kill her.
Nicole Didyk, MD says
I can understand feeling angry and frustrated at your mom’s situation and I’m glad to hear that her pain has gotten better.
Many older adults can have worsening brain function when they’re under stress, like being in hospital, in pain, and taking certain medications. As a Geriatrician, I don’t suggest doing a memory test under those conditions, as the results might not be reliable. There’s also the risk of a person having delirium when in hospital, which can look a lot like a dementia, but is almost always reversible.
In a situation like the one you describe, it may be that there was some other information provided to the hospital team that led them to those conclusions. A more thorough evaluation that’s done when a person is back to their usual baseline is likely to be more accurate. That would be something to request from a primary care doctor, or through a referral to specialized Geriatric services.
In most regions, a family doctor can review the reports from the hospital and determine whether they can send paperwork in to the Ministry of Transportation to remove a suspension from a license.
Concerned Daughter says
I’m so glad I found this website! I’m in a dilemma. My 84 yr old father has minimal mobility in his legs and cannot walk, he has lost most of his leg muscles and PT have said there’s not much they can do at this point, so he’s practically wheelchair bound.
He’s always been stubborn and refused to ask for help so he would fall plenty. My sister is his care taker. Recently he’s been taking too many risks, like standing up in the middle of the night to go urinate even though he has a urinal bottle, standing up to shave, and standing putting on pants all refusing to call my sister for help. He’s fallen in 2 months more than 10 times, he’s gotten stitches, scrapes and bruises. We have explained to him about safety and how important it is for him to call for help. Recently he fell in the bathroom and my husband had to drive over to help my sis because she’s hurt her back from picking him up. Today he fell again and he broke furniture in his room for trying to lean on it. When I spoke with him, he was not concerned about the severity of this situation, he was more worried about the item he was trying to get in the first place. I mentioned we may not be able to care of him due to the safety issue and all he said was he’s not going to a nursing home, he’ll find somewhere to live. This is just one part of the issue, he has this obsession with his money and is constantly purchasing things online, random things show up that he purchases. He has canceled his debit card about 20 times because he will subscribe to things and then not know how to cancel, he will forget his password and cannot get into his bank then he calls the bank but because has has severe slurring No one can understand what he’s saying, he also has difficulty eating and constantly slobber, due to mobility in his mouth. I know he needs 24 hour care but I don’t know how to prove it, diagnose him or even what the next step is!! We need help!
Nicole Didyk, MD says
Hi Leisha, and it sounds like you’re very right to be concerned. I’m all for allowing individuals to live with risk if they’re capable of making that decision, but it is vital to make sure that there isn’t a medical issue that is affecting an older adult’s judgment, before using the “tough love” option.
Forgetting things like previous purchases, or even a change in buying habits itself could be a sign of dementia , which could mean that your dad isn’t capable of deciding where to live, or what type of help he needs, or at the very least, will need help making those decisions.
A first step might be to try to emphasize the common ground that you kids have with your parent, such as wanting to keep him at home. It can be helpful to indicate that you need more medical information to keep him at home, and going to the doctor to get a thorough evaluation (preferably by a Geriatrician!) is what needs to happen.
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
KPH says
This website – and this article – has been extremely helpful to me so thank you for utilizing your expertise to provide us with more knowledge around this issue. I hope it’s not too late for me to get some guidance.
My father (age 71) was hospitalized in July 2020. A neighbor found him and he was dehydrated and malnourished (my father has swallowing issues from surgery for oral cancer back in 2007, but he’s learned to manage them and we thought they were under control). I had him sent to the ER and when I went to visit him I learned he lost close to 50lbs! I ended up authorizing them to install a PEG tube because the doctors believed his swallowing issues relapsed and he wasn’t able to ingest food properly.
On top of that he was extremely confused. He kept mentioning my grandfather who passed away and all of these other dead people.
I had him transferred to a SNF so he could receive therapy to restore his strength and relearn to swallow. Once he got more nutrition in him it was very clear how confused he is. His short term memory is basically nil. He calls me like 20-30 tiles a day and often asks the same questions. He always asks if there is a wedding and gets very confused when I ask him who is getting married. And what’s very interesting is he brings up all of these people that have passed on (my mother/his wife, both of his parents). His mind has gone back to a place it seems where he has experienced no trauma.
After weeks of this, I had him evaluated by a neurologist. She ordered an EEG (results came back normal), gave him the MMSE via computer and she noted there was marked impairment (this was my father’s first time ever using a computer so I don’t think this have a completely accurate picture of his baseline) and the MRI revealed “mild small vessel ischemic changes in supratentorial white matter and few [specifically 2] small chronic infarcts in basal ganglia”. The doctor said she believes he has vascular dementia. He had a CAT scan when he was in the hospital and it didn’t pick up these silent strokes as she called them.
I guess my question is could this have happened this suddenly? Literally, one day I was talking to him and the next day he’s super confused. His primary diagnosis when he left the hospital was encephalopathy, and now it’s evolved to this. Other than the weight loss, he’s shown no other signs of cognitive decline. He paid all bills on time, made all of his appointments and had an excellent memory. It literally all changed within a day which is baffling to me. I’m feeling like I should get a second opinion and have a more thorough assessment done, but that could be me in denial.
I appreciate any insight you could share.
Nicole Didyk, MD says
Thanks for sharing your story and I’m so sorry to hear that your dad has had such a rough time. When cognitive changes seem to happen suddenly, it could be related to a new stroke, and sometimes those aren’t picked up on a scan, even though we may see older, or chronic, changes.
But your story makes me think about delirium, which can be difficult to distinguish from dementia, as I explain in this video.
Delirium is almost always a temporary condition, due to a medical illness, but it can take weeks or months to completely reverse, and some older adults never seem to return to their previous baseline. The best thing when someone is recovering from delirium is to get into a routine, with as many familiar activities and faces as possible. It often takes months to determine what a person’s new “baseline” will be.
KPH says
Thank you for responding Dr. Didyk. Was the neuro eval/diagnosis too soon? I’m here trying to determine his long term care options but I’m scared to make any drastic changes if it isn’t dementia. It literally happened over a matter of days. Prior to this my father was paying bills, driving, remembering perfectly.
Should I get a second opinion or proceed with him with this vascular dementia diagnosis? I’m curious if I should continue with a neurologist or a geriatrician.
Thank you so much for responding!
Nicole Didyk, MD says
I’m glad you found the information to be helpful! In my work as a Geriatrician, I see folks like your dad all the time, and can provide a comprehensive assessment, which can really help to clarify prognosis and guide future planning. I’m all for a consultation with a geriatrician in a situation like you describe!
The other resource that you would find helpful is Dr. Kernisan’s Helping Older Parents Membership. It’s a unique and affordable program she founded to answer questions and support people helping aging parents.
The membership provides ongoing guidance from her and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here.