Monday, April 23, 2012

Prevalence of Dementia and Diagnosis Tools

Photo by Allesandro Prada
As the population in the United States ages, there will be accompanying increases in age-related ailments.  In addition to sizeable increases in the number of people living with chronic diseases, such as diabetes, the U.S. population is facing an increase in the number of people living with dementia. 

Recent statistics demonstrate that “Alzheimer’s disease (AD) alone affects approximately 5.3 million Americans and is projected to affect 13 million people by 2050” (Christensen et al 2011).   The risk of acquiring AD increases with age, with most symptoms appearing in people 60+.  About 13% of those 65+ have AD, and those 85+ are 14 times more likely to have AD than those 65 to 69.  AD is currently the sixth leading cause of death in the United States (Padilla, 2010).  

As Baby Boomers are turning 65 this year, medical advances are extending their lives so that a larger percentage as well as a larger number of Americans will live beyond 85 than ever before.  Although there are some medications that can ameliorate its symptoms, currently, there is no cure for AD.  

There are multiple causes for dementia, some of them reversible or at least static. However, the types of dementia that require the most intervention are those that are irreversible and progressive.  The most common causes of dementia listed are as follows in order of most prevelant to least prevelant: Alzheimer’s disease, Parkinson’s disease, vascular dementia, and Diffuse Lewybody disease.

Casual observers might mistake confusion, depression or age-related cognitive decline for dementia.  Most mental confusion is temporary and due to treatable conditions such as low blood sugar, infections, or polypharmacy. These problems need immediate attention. Many older adults suffer from depression, which can affect the ability to concentrate.

Age-related cognitive changes include a degree of short-term memory problems, problems with word retrieval, word substitutions and slowing of executive planning and working memory. For a proper diagnosis, people displaying changes to their cognition should consult a physician, who after excluding other causes treatable by a general physician might make a referral to a neurologist or psychiatrist in order to undergo additional testing. 

A common diagnostic tool mentioned in connection to dementia is the Mini-Mental State Examination (MMSE).  According to the Alzheimer’s Association webpage, the MMSE is a 30 question test that measures cognition.  Normal scores are considered 25 to 30. Scores between 24 and 21 suggest the possibility of mild dementia.  Scores between 20 and 13 refer to moderate levels. Scores less than 12 indicate a severe state. 

A diagnostic tool growing in use is the BCAT (Brief Cognitive Assessment Tool). Normal score ranges from 46 to 50; mild cognitive impairment scores range from 34 to 46; mild dementia scores range from 26 to 36; severe dementia scores range from 0 to 25. 

Other diagnostic tools are also available, such as the American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA FACS).  The ASHA FACS focuses more on functional tasks as measuring these four domains: 1) social communication, 2) communication of basic needs, 3) reading, writing, and number concepts, and 4) daily planning (de Carvalho et al 2008). The appendix included in their article provides more concrete examples of what skills are tested in each of these four areas, which helps newcomers to understand specifically how a person with dementia may struggle to complete daily tasks.

Even though there is no cure for many forms of dementia, there are some new medications which help to slow down the progression of these diseases.  It may be uncomfortable to suggest that your spouse or parent be tested, but you may be buying them more time and greater understanding about the reason for cognitive changes if they do see a neurologist, psychiatrist or speech language pathologist for testing.

Related:

Is It Dementia or Delirium?
Mild Cognitive Impairment
Activities of Daily Living and Instrumental Activities of Daily Living
Long-term Care Is More Probable as We Age
Coping with Illness

1 comment:

  1. Dementia is a deterioration of mental condition. Dementia usually occurs in later life, though rarer cases of presenile dementia are diagnosed.

    Dementia specialist

    ReplyDelete