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Tuesday, June 19, 2012
Dr. Camardi: I am writing you because I need some clarification of the diagnosis of dementia and I need to offer you an apology.
Me and my brother brought our father to you last month because we did not want to hear what you and subsequently another doctor said our father had. I don’t understand how after you instructed your resident to ask four little questions that you could say that Dad had the stages before dementia. That was exactly what we hoped we would not hear.
Because I did not want to hear the truth , I may have been a little rude with you and I apologize for that.
We proceeded to take Dad to another specialist . Well, we spent the whole day getting Dad tested, and the other doctor said the exact same thing you said, that took you 10 minutes. How can this be?
No apology necessary. More than anything else, I think you were mad at the disease of dementia. What you saw me do was perform a questionnaire generated from a study reported in the British Medical Journal in February that can give early insight into the possible beginnings of dementia, called amnesiac mild cognitive impairment or aMCI.
We all undergo some degree of memory loss as we age and it is important to tell the difference between normal aging and dementia.
Certain aspects of dementia present earlier than others. Knowing this pattern allows us to introduce those patients to more involved testing, which is why I referred you to the Center for Healthy Aging .
You decided to go elsewhere and that’s fine, as long as your dad got the work-up he deserved.
What the authors did was to take the “Alzheimer’s Questionnaire” as published in the Journal Of Alzheimer’s Disease last year, and when the working definition of aMCI was applied to the responses , answering yes to four questions identified those patients who need comprehensive testing.
These four questions represent the most common complaints families or patients present when dementia is a concern. The questions all deal with contextual observations of the patient’s behavior .
Answering any of these questions affirmatively represents “red flags” that must be brought to the attention of the patient’s health care provider :
1. Does the patient constantly repeat the same question and/or statement over and over again (I use three such repetitions as my criterion )?
2. Does the patient frequently get lost going from place to place ?
3. Does the patient have difficulty recalling dates, seasons or time of day (or need consistent prompting to recall)?
4. Does the patient show a lack of responsibility in managing finances ?
What is important in all of this is to identify patients at an early stage who can be helped to preserve and strengthen their memory and minds .
Many times we can and do make important improvements to a person’s memory and mental functioning by addressing and stressing my keys of integrative geriatic care: blood pressure control, blood sugar management, weight reduction, daily exercise, smoking cessation, consistent cholesterol control, alcohol in moderation, good sleep habits and inter active brain function at least three times per day (this will be dealt with in an upcoming article).
Does it not seem that the best defense against dementia is a common sense lifestyle?
None of this involves a grand expansion of national health care programs but it does involve a commitment, dedication and focus of the patient and the provider to “pay it forward.”
Do the good hard work it takes to maintain one’s health when you have the health to do it! And in so doing, we can continue to make contributions to our tomorrows and to the lives of those around us.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.
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