ADRD Detection & Diagnosis

Identifying Alzheimer’s disease and related dementias (ADRD) begins with a conversation with a health professional such as your primary care physician (PCP) or nurse practitioner (NP) who you see regularly when you receive your annual physical, vaccinations, or when you are sick.

Knowing the 10 Steps to Approach Memory Concerns can help you feel more confident in assessing the situation and taking appropriate action.

Please Note: The information on this page should not be used as a diagnostic tool and is not a substitute for informed medical advice. If you are concerned that you or someone you know has dementia, please talk to your healthcare provider.

Several medical conditions and factors can mimic the symptoms of dementia, leading to a misdiagnosis. These conditions often result in cognitive decline, memory loss, and behavioral changes.

Some of the most common conditions include:

  • Depression: Depression can cause significant cognitive impairment, including memory problems, difficulty concentrating, and confusion. There is a 10-question, Online Depression Screening available at the TN Department of Mental Health & Substance Abuse Services.
  • Delirium: This sudden change in mental status, often due to infections, medications, or metabolic imbalances, can cause confusion, disorientation, and hallucinations, resembling dementia.
  • Vitamin Deficiencies: Deficiencies in certain vitamins, particularly B12 and folate, can lead to cognitive decline, memory loss, and other neurological symptoms.
  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause cognitive issues, such as memory problems, confusion, and difficulty concentrating.
  • Normal Pressure Hydrocephalus (NPH): This condition, caused by an abnormal accumulation of cerebrospinal fluid in the brain, can lead to memory problems, gait disturbances, and urinary incontinence, which are like dementia symptoms.
  • Medication Side Effects: Certain medications, especially sedatives, anticholinergics, and some pain relievers, can cause cognitive impairments that resemble dementia.
  • Chronic Alcohol Use: Chronic alcohol use can lead to cognitive decline and memory problems. Visit this link to learn more about Treatment & Recovery.
  • Infections: Infections such as urinary tract infections (UTIs) or chronic infections like syphilis or HIV can cause cognitive changes and confusion that may be mistaken for dementia. Local health departments offer free and confidential testing.
  • Sleep Disorders: Conditions like sleep apnea can cause fatigue, memory issues, and difficulty concentrating, which can mimic dementia.
  • Brain Tumors: Tumors in certain areas of the brain can cause cognitive decline, personality changes, and memory loss, like dementia symptoms.
  • Chronic Pain or Stress: Persistent pain or high levels of stress can impair cognitive function and memory, leading to symptoms that may be confused with dementia.

It is essential for healthcare providers to thoroughly evaluate and rule out these conditions before diagnosing dementia, as some of them are treatable and reversible.


Sources:

ADRD is diagnosed through a complete evaluation process that involves several steps.

There is no single test that can confirm a diagnosis of ADRD, so healthcare providers use a combination of methods to assess cognitive function and rule out other possible causes of symptoms.

  • Medical History: The healthcare provider will ask the patient about their symptoms, family history, and any changes in thinking, memory, or behavior. The provider will review all current and past medications to identify and medications that may cause cognitive impairment.
  • Physical Exam: A physical check-up will help rule out other conditions that might cause memory problems, like infections, heart disease, or thyroid issues.
  • Neurological Exam: This exam will assess reflexes, coordination, muscle tone and strength, eye movement, speech, and sensation to detect any neurological problems.
  • Cognitive Exam: Tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) are commonly used to assess memory, attention, language, and other cognitive abilities.
  • Lab Tests: Blood tests can check for conditions that might cause symptoms like dementia. In some cases, particularly when there is a strong family history, genetic tests may be requested to look for changes associated with ADRD.
  • Brain Imaging: CT or MRI scans detect brain issues like tumors or strokes, while PET scans identify Alzheimer’s disease by revealing amyloid plaques and tau tangles.
  • Functional Assessment: This involves evaluating the patient’s ability to perform daily activities, such as managing finances, cook, or personal care.
  • Mental Health Assessment: A psychiatric evaluation may be conducted to rule out conditions like depression or anxiety, which can cause symptoms like dementia.
  • Monitoring Progression: Because dementia symptoms often develop slowly, the doctor may monitor the patient over time, reassessing cognitive function and daily living abilities.
  • Referral to Specialists: The patient may be referred to a neurologist, geriatrician, or neuropsychologist for further evaluation and confirmation of the diagnosis.
  • Communication of Diagnosis: The doctor will discuss the diagnosis with the patient and their family, explaining what it means and what to expect. They will also discuss treatment options, care planning, and available support services.


    Sources:
  • National Institute on Aging (NIH), How is Alzheimer’s Disease Diagnosed?
  • Alzheimer’s Association, How is Alzheimer’s Disease Diagnosed?
  • Alzheimer’s Association, Medical Tests for Diagnosing Alzheimer’s

After a dementia diagnosis, the next steps are not always straightforward or linear because each person’s situation is unique. Here are some key steps that may help navigate the diagnosis:

alzroad

Understand the Diagnosis


Build a Care Team


Create a Care Plan


Legal & Financial Planning


Support & Resources


Stay Engaged

There are currently NO known interventions that will CURE dementia.

Medication, supportive therapy, and lifestyle changes are key components in treating dementia. Medications may help manage symptoms and slow the progression of the disease, supportive therapy can help with behavioral and emotional needs, and lifestyle changes promote overall well-being.


Learn More

A well-coordinated Care Team and comprehensive Care Plan are the most effective supports for the treatment and management of dementia.

 

Care Team

A Care Team for someone with dementia typically includes a mix of healthcare professionals, family members, caregivers, and community resources which may include, but is not limited to:

  • Primary Care Physician (PCP): Oversees general health, provides regular check-ups, manages medications, and coordinates care with specialists.
  • Neurologist/Psychiatrist: Specializes in diagnosing and managing dementia and related cognitive disorders.
  • ·Geriatrician: Focuses on the unique health needs of older adults, including those with dementia.
  • Nurse or Nurse Practitioner (NP): Provides regular check-ups, manages medications, and monitors health.
  • Social Worker/Dementia Navigator: Helps navigate community resources, legal issues, and provides emotional support resources.
  • Occupational Therapist (OT): Assists with adapting daily activities and home environments to maintain independence.
  • Physical Therapist (PT): Helps with mobility and physical activities to maintain strength and balance.
  • Speech Therapist: Supports communication and swallowing issues that may arise with dementia.
  • Caregiver: Often a family member or hired help, the caregiver plays a central role in daily support and care.
  • Community and Support Services: Include dementia care specialists, support groups, respite care providers, faith and religious communities, and elder care services.

 

Care Plan

A Care plan is a personalized roadmap for managing dementia. It is created with input from the Care Team and the individual with dementia (when applicable) including:

  • Medical Management: The care plan includes a schedule for medications prescribed to manage symptoms, slow the progression of the disease, or treat co-existing conditions like high blood pressure or diabetes. It details the dosage, timing, and purpose of each medication and any known medication allergies. Regular monitoring is set up to assess the effectiveness of the medications and to watch for any side effects. It also includes a schedule of regular visits to the PCP, neurologist, or other specialists to monitor the progression of dementia. This ensures that any changes in symptoms or overall health are promptly addressed. If the individual has specific needs, such as psychiatric care for mood disorders or physical therapy for mobility issues, these are integrated into the plan.
  • Caregiver Details: The plan includes details about current caregivers such as name, contact, and address. The plan includes contacts in case of emergencies when the primary caregiver is unavailable for any reason. Power of attorney documents may be attached or included as part of the care plan to ensure decisions are being made by the appropriate individual.
  • Advance Directives or Physician Orders for Scope of Treatment (POST): Advance Directives or POST forms may be attached or included with the care plan to express the healthcare wishes of the individual with dementia when the individual is incapable of making their wishes known. More information about Advance Directives or POST forms can be found here.
  • Daily Living Assistance: The care plan includes strategies for helping the individual with activities of daily living (ADLs), such as bathing, dressing, eating, and using the bathroom. It should include required assistive devices such as glasses, hearing aids, dentures, walkers, or canes. It might include home modifications to improve safety, like installing grab bars in the bathroom or removing tripping hazards.
  • Cognitive and Physical Activities: To keep the mind active, the care plan includes activities like puzzles, reading, or memory games. These activities are chosen based on the person’s interests and abilities. Physical exercise is also part of the plan, encouraging activities like walking or stretching to maintain physical health. The plan might outline the time of day the individual likes to perform exercise or perform certain activities.
  • Emotional and Social Support: The plan includes opportunities for social interaction, such as visits with family and friends or participation in community programs. This helps reduce feelings of isolation and supports emotional well-being. Counseling or therapy may be included to help the individual and their caregivers cope with the emotional challenges of dementia.
  • Nutritional Guidance: The care plan includes a balanced diet that meets the nutritional needs of the individual, considering any difficulties with swallowing or specific dietary restrictions. It may also outline meal planning and preparation to ensure that the person is eating regularly and healthily. The plan may indicate the individual's personal preferences and known food allergies.

By addressing both medical and supportive aspects, the complex needs of individuals with dementia and their caregivers can be effectively met.

More information from the CDC - Creating a Care Plan.

Palliative medicine is specialized medical care aimed at providing relief from the symptoms and stress associated with serious illnesses. Palliative care is specialized care for people facing serious illness, focusing on providing relief of suffering (physical, psychosocial, and spiritual), to maximize quality of life for both the patient and family. Within palliative care, serious illness is defined as a health condition that carries a high risk of mortality and:

  • Negatively impacts a person’s daily function;
  • Negatively impacts a person’s quality of life; and/or,
  • Excessively strains the person’s caregiver.

Dementia palliative care focuses on improving the quality of life for people with dementia by addressing their physical, emotional, and spiritual or religious needs. The goal is to provide comfort and support. This type of care often involves symptom management, emotional and psychological support, coordination of care, support for decision-making, and end-of-life care and planning. 


Learn More

 

Sources