Diagnosing and Treating a Loved One's Dementia, with Rajesh Tampi, MD, MS

As the average American’s age continues to rise during the latter years of the Baby Boomer generation, the prevalence and effect of dementia on the population has become a major matter of public health concern. In fact, it is estimated that the prevalence of Alzheimer disease—the most common form of dementia—will triple over the next 25 years. In that time, more than 150 million individuals globally will be estimated to be affected by any form of dementia.

Despite the growing prevalence of dementia and Alzheimer disease, there still is a great deal of misinformation surrounding the condition: how and when it presents, its progression, and the ways it can be adequately treated.

In a recent interview with The Educated Patient, Rajesh Tampi, MD, MS, professor and chairman of psychiatry at the Creighton University School of Medicine, discussed the intricate process of detecting, diagnosing and facilitating care for dementia. Tampi’s discussion is broken into three segments, as displayed in the video playlist above and in the navigable list below:

• Spotting Symptoms of Dementia
• How Dementia is Diagnosed
• Helping a Loved One Through Dementia

Here are some of Tampi’s key perspectives on the dementia diagnostic and care process.

On the importance of seeking a medical professional to diagnose dementia

“People think that as you age, memory and cognition, or other parts of your thinking process, decline. The truth is that with aging, yes—there are some memory changes. But dementia as a process is pathological. That means it is a disorder and it needs to be evaluated by a medical professional and an appropriate diagnosis given. If you as a loved one, or you yourself are having starting to have any memory problems, you should first make sure that you make an appointment with your primary care physician.”

On the differences between dementia and delirium

“If it is a sudden onset of memory problems and other cognitive changes, it is usually not a dementia. It is what we call a delirium, and delirium is a medical emergency which needs to be appropriately worked up and treated. And the treatment of delirium is treatment of the underlying condition, and it is usually a treatable condition.”

On the behavioral symptoms of dementia

“Apathy—that is, the lack of initiative in doing things—is the most common behavioral and psychological symptom seen in about 70 to 90 percent of patients. It starts early on in the illness and remains throughout the illness. People can have depressive symptoms, which can occur at any time. People start feeling low, they start crying, they stop eating, they stop taking care of themselves. They have become helpless and helpless, and they can have suicidal thoughts.

Or patients can have severe anxiety. They become worried. They tend to focus on things that are small, they exaggerate them, and they constantly perseverate on them. Patients can have what we call a psychosis—that is, they have delusions which are false, fixed beliefs. Or they may have hallucinations. They start seeing things, hearing things, feeling things. Or patients may have significant mood swings.”

On how to prepare for an initial dementia discussion with a clinician

“What the primary care physician will do is take a good history. They will get a timeline. One thing I always tell caregivers to do is, 'If you have a diary, note those things down before you go see a doctor, so you can have a clear thought of what you're going to describe to the doctor as the problems with your loved one.' So, take notes on what symptoms you see. How when did they start? How did they develop? Did they happen overnight? Did they happen over periods of a week or months? Or did it happen after a medical issue?

Then the doctor can differentiate between delirium, which is a medical emergency that happens very quickly, versus dementia, which happens slowly over a period of time. Another thing that you want to make sure is you want to take a good note of all the medical problems or surgical problems that your loved one has, which will help the doctor differentiate why your loved one is having these kinds of symptoms and psychiatric problems that can cause behavioral issues. So, if a patient is in pain and now they are having dementia, they can get agitated.”

On how clinicians assess for dementia

“We now do what is called the Montreal Cognitive Assessment, or the Mini Mental State Examination. These are screening tools—they're not diagnostic tools, because dementia is a clinical diagnosis. It is made by a specialist after reviewing all the information, ruling out all the medical and psychiatric causes, and then a diagnosis is given.

The doctor may get some simple lab work—they will actually take blood. They will take urine to rule out any infection, any metabolic problems like diabetes, kidney disease, liver disease and those kind of things. They will look for vitamin deficiencies because those all can cause cognitive issues. So, they will do the workup and then come up with a presumptive diagnosis of whether this is dementia versus delirium, and what is the reason for the dementia.”

On how to assist a loved one being affected by dementia

“When a patient gets demented, their 'feeling' part of the brain remains well, but the 'thinking' part doesn't work well. Som they can understand emotions, they can remember some of the emotions, but they cannot comprehend the aspects of problem-solving. So, confrontation only will lead to worsening on the situation, not betterment. So redirect— just roll with the punches and don't confront. Engaging the loved one in positive conversations, in productive conversations, and making them do things that they enjoy all can reduce behavioral symptoms including agitation, depression, anxiety.

For apathy, there are not many things including medications that really help. What evidence suggests is you may have to be the person who is going to encourage and help the person move ahead. So rather than telling, start doing with your loved ones so that they are more socially engaged, more physically engaged.”