Monday, March 27, 2017

Results section


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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