2017-11-22 / Front Page

After diagnosis, treatment of Alzheimer’s disease & dementia still challenging

by Kate Evans

This is the second in a series of articles about Alzheimer’s disease and dementia.

The diagnosis of Alzheimer’s disease and dementia comes from ruling out other conditions through extensive testing, said Carolyn Canini, program director for the Alzheimer’s Association-West Virginia chapter. It may take a long time to get a final diagnosis for some.

Doctors do a physical exam, get a medical history, check mental status and may do a neurological exam evaluating reflex, eye movement, speech and coordination, she said.

They also check medications and dosages for interactions and side effects, and look for infections, stroke, tumors and other neurological illness.

One thing Canini sees a lot are urinary tract infections, which can often cause thinking changes and confusion in the elderly.

Cindy Kennell, War Memorial Hospital nurse and case manager, said if patients have memory issues, the first thing staff checks is the urine. Nurses also perform a mini-mental exam, blood tests, rule out medication reactions, possibly do a CAT scan or MRI and also check for psychiatric problems, especially if it’s a new onset of symptoms.

Dementia tests

Hancock physician Dr. Matthew Hahn first does a five-minute mini-mental status exam when a patient expresses memory concerns.

While it’s not a perfect diagnostic tool, it does distinguish fairly serious cases of dementia pretty well, he said.

Hahn also does a battery of tests when a patient is having memory loss or cognitive impairment in hopes of finding something that’s easily reversible.

Tests include metabolic, thyroid, liver and kidney functions and vitamin deficiencies such as Vitamin B12 and folic acid. He also checks for all types of infections, medication causes, depression and other illnesses.

Hahn said that while cognitive impairment isn’t a common manifestation of Lyme disease, it’s certainly appropriate to test for it in our area, he noted. Usual Lyme disease symptoms are a rash, flu-like illness, headaches and pain. Short-term memory problems have been associated with Lyme disease.

While many tests are run before a diagnosis of Alzheimer’s disease or dementia is made, Hahn said that rarely has he ever found a reversible cause in his practice.

Hahn has treated many cases of Alzheimer’s disease and dementia over the years and noted that he is seeing increases in those diseases in his patient population, which is aging.

Hahn said that most cases he sees are Alzheimer’s disease, with vascular dementia ranking second. One of the major forms of dementia is vascular dementia and the risk factors are the same as for heart disease and stroke, he said.

Prevention, treatment

Hahn recommended eating a diet of healthy foods, exercising regularly and keeping the mind active with crossword puzzles and stimulating activities as being beneficial in helping to prevent dementia and urged people to take better care of themselves.

Hahn said a number of well-known medications are specific to treating dementia, but clinical data shows their impact is pretty minimal.

“People have the incorrect impression that there are ‘memory pills’ or medicines that significantly improve the patient, but that’s not really the case. The medications prevent the progression of cognitive impairment for a temporary period,” Hahn said.

It’s reasonable to try these medications under many circumstances. Family members indicate that patients’ symptoms improve on the medications, “but they’re not the miracle we need,” he noted.

Hahn felt the most exciting work now is being done in immunotherapies and even vaccines that could reverse the disease.

“In the next 10 or 20 years we might be able to get there,” he said of a cure.

Other issues

Other big issues for Alzheimer’s disease and dementia patients can be anger, depression, hallucinations and even violence and all these can fluctuate during the day, Hahn said. There’s pressure for doctors to prescribe dementia medications and also the need to keep patients calm.

Typically that’s done with benzodiazepines and Zanax, but those medicines can diminish cognitive function and increase the risk of falls in the elderly. If patients use them, they have to use them carefully, he stressed. There’s also the use of anti-psychotics, which is very controversial.

Patients may also be on other medications for chronic health conditions. Physicians have to weigh the risks and benefits of all medications that patients are on and their possible interactions that could worsen their dementia symptoms.

“There are no easy decisions,” Hahn said.

Hahn said most personality changes he’s seen in his dementia patients are for the better --they’re taking it all in stride and seem happy. Most remain in good health and are able to stay at home.

Lack of resources

Hahn said he finds the biggest challenge in treating patients with Alzheimer’s disease and dementia is the gap in any form of resources for people that need a little assistance to stay in their homes and that aren’t ready for nursing home care.

Caring for Alzheimer’s disease and dementia patients can be a challenge but that doesn’t mean they can’t stay in and remain comfortable in their own home, he said.

Hahn said some types of minor assistance barely exists. The needs are respite care for the caregiver and helping people around the house with basic chores and housekeeping.

As Alzheimer’s disease and dementia progress, it becomes really difficult for caregivers to not only deal with the patient’s memory impairment, but also cope with their loved one’s personality changes, fluctuations and their ability to process information, Hahn said. As far as he’s aware, health insurance doesn’t really cover any services that are helpful in this regard. The burden falls on families.

In this area there are private caregivers but typically families have to pay for it out of their pockets.

“How do we get people the care they need in their own homes when there are not really reliable clinical treatments,” Hahn asked.

Hahn said there are challenges in every aspect of treating and diagnosing Alzheimer’s disease and dementia patients. He hopes the community will look at ways to increase resources for these patients with families, neighbors, churches, senior centers and other agencies working together to help with a disease that is challenging America.

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