2.
Diagnosis Results
2.1 The four phase
assessment task
There are four
phases used when it comes to diagnosing early onset dementia (EOD). In
reviewing the peer review journals regarding how physicians diagnose early
onset dementia (EOD) almost all of my references agreed upon and reported about
the four phases of the assessment process; (a) initial awareness, (b) workup or
assessment, (c) determination and charting of diagnosis, and (d) disclosure of
the results of the assessment to the patient and/or family members (Boise,
Camicioli, & Morgan, D, 1999; Buntinx, De Lepeleire, Paquay, Iliffe, &
Schoenmakers, 2012; Chertkov, Massoud, & Nasreddine, 2008;
Draper, Low, & Withall, 2009; Feldman, Jacova, & Rouillard, 2008; Harwood,
2012; Pim van den, Dungen, & Moll, 2016; Sandilyan, & Dening, 2015; Van
Vliet, de Vugt, & Bakker, 2011; Weatherhead, & Courtney, C, 2012).
When analyzing the first phase, which
is initial awareness phase, it was clear from the interviews that the family
plays an important role in bringing their loved ones to a physician when early
onset dementia is suspected. It was reported that about 90% of the cases
regarding EOD (early onset dementia) were brought to the attention of the
physicians by family members of the patients.
During the interviews barriers regarding the recognition of dementia
symptoms were recognized. Physicians have a limited amount of time that they
are given with the patients, doctor’s attitudes, and their recognition of the
need for a dementia assessment was just a few of the areas that were discussed.
These areas noted were suggested items that need improvement. There is a
general consensus among experts on recommended procedures for the diagnosis of
dementia.
The second phase, the assessment/workup phase,
the physician interviews the patient and the family members (if they have any)
asking them about what difficulties in functioning due to cognitive problems
that the patient is experiencing. They were also given mental status tests
using standardized instruments, and a few laboratory tests, that analyzed their
complete blood count, liver function, blood chemistry, and determination of
thyroid stimulating hormone levels. The testing of the patient’s thyroid
hormones can rule out reversible forms of dementia.
The third phase, the determination of
diagnosis phase, specific items are ruled out. This helps get a true diagnosis
of dementia. Most of the physicians interviewed would give a firm diagnosis of
dementia especially if the patient had abnormalities on neurological
examinations. One main key factor is when a patient has difficulty in
left-right difference in motor sensory findings. All the findings pointed to
the fact that there is limited treatment options and that the medications used
to treat this chronic disease aren’t the greatest. In other words there isn’t
much that can be done for the patient when it comes to dementia as a whole.
The four and final phase, the disclosure
phase, is when the patient and/or family is notified of the findings. The
physicians that were interviewed said they chose their terms carefully when
diving them the diagnosis. The physicians felt using the term dementia was
gentler than telling them that they have Alzheimer’s disease. They feel that by
delivering the correct diagnosis helps prepare the patient and family for the
tough road that is ahead of them. Physicians in rural areas noted that they
were concerned about the welfare of their elderly patients when it comes to the
care they will receive due to the limited assess available in rural areas.
Usually in a small town the physician carries the brunt of the burden of having
a patient with dementia. Physicians were noted to have helped their patients
and their families manage their living condition.
2.2
Interview and Survey
Some information from the interviews
coupled with a survey will help a person better understand the issues involved when
it comes to the early warning signs representing someone who might have early
onset dementia. There is an initial awareness phase. There are barriers when it
comes to recognizing dementia symptoms when they surface. In one of the
interviews about 99.9% of the physicians where in agreeance regarding there
being barriers in diagnosing dementia. One of the physicians’s stated that:
I
know I’m guilty of it, and suspect the rest of us are too…which is that, with
someone’s who’s been your
patient for a while and, you haven’t done a Mini-Mental State Exam on them.
It’s very easy to talk to people with dementia and say,
“Hi,
how ya doin?”
“Great.”
“Feeling good today?”
“Yeah.”
“How’s that blood pressure medicine
working?”
“Good.”
“You taking it right away?”
“Yeah, just the way you told me doc.”
Then,
you give them a Mini-Mental State (Examination), and you go “Oh my
goodness.” That could be very easy to
miss (Boise,
Camicioli, & Morgan, 1999).
The
signs people with early onset dementia are called triggers. The below survey
displays triggers mentioned and the number of groups that are mentioning them.
Triggers
Mentioned
Number of Groups Mentioning
Family
brings in patient or raises concerns
16
Problems
identified during office visit
Memory/thinking problems identified
during history taking
11
Medication
problems
8
Patient
symptoms, e.g. weight loss,
appearance, difficulty in functioning 6
Patient
self-report
4
Change
in physician results in identification 2
Problems
identified in health setting outside
Office
visit
Nursing or other staff identify
problems
5
Dementia identified in emergency room,
hospital, or nursing home 4
Missed
office visits
2
Problems
identified in community
Friends, neighbors, or church members
contact doctor
5
Car accidents
4
Accident or fall at home
3
Change
in patient’s living situation,
loss of spouse, etc.
3
Police
refer patient
2
Patient
got lost
2
Workplace
referral
1
The
above triggers give you a general idea on what is looked at when the early
onset of dementia is suspected.
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