Σάββατο, 7 Μαΐου 2016

Symptoms and Diagnosis of Dementia

When it comes to neuropsychological disorders, it is mainly in the field of psychiatry and neurology to conduct the diagnosis and form a conclusive supported opinion. Yet it is mainly in the field of psychology to deal with the diagnosed population in a daily basis and ensure a delay of the progression of the disease. Thus, psychologists have some means of forming a diagnosis- that is to make sure that the disorder is indeed dementia, and specify on its subcategories and stages.
But first one should be familiar with the disorder itself. Dementia is fatal disease, for which there is still no absolute cure. It is a degenerative disorder of the brain- to use the exact words of the DSM-IV, dementia 'is characterized by the development of multiple cognitive deficits'. What happens really is that the brain progressively loses function of some of its parts, until they cease to work at all. Dementia can affect all aspects of the brain, and it is a disorder that manifests itself differently in each person, exactly because each has a unique combination of affected areas. It can be observed mainly in the population of the elderly, where brain deterioration occurs anyway, but dementia may appear to individuals of a very large age range. Dementia has many subcategories:

  • Dementia of the Alzheimer's Type
  • Vascular Dementia
  • Dementia due to HIV
  • Dementia due to Head trauma
  • Dementia due to Parkinson's Disease
  • Dementia due to Huntington's Disease
  • Dementia due to Pick's Disease
  • Dementia due to Creutzfeldt- Jacob Disease
  • Dementia due to Other General Medical Condition
  • Substance- Induced Peristing Dementia
  • Dementia due to Multiple Etiologies
  • Dementia Not Otherwise Specified
It also has many stages of progression- some researchers consider five stages, while others three, which is the most common categorization (for example through the Clinical Stages of Dementia questionnaire). Since the disease is progressive, most of the times, individuals will begin in the early stages and will continue to the others.
In order for someone to be diagnosed with dementia, they have to experience cognitive deficits, manifested in memory impairment (meaning both having trouble in recalling as well as in learning new things), and at least one of the following symptoms: aphasia, apraxia, agnosia, and disturbance in executive functioning (as the DSM- IV states). The deficits described must be at an extend that alter the everyday functioning of the person (socially, occupationally). Each subtype of the disorder has some more specific symptoms that assist the diagnosis- consult the DSM- IV or other neuropsychological manuals for that.
There are plenty of ways to diagnose dementia, most of which are neurological tests. For psychologists, the easiest, quickest and most accurate way to form a solid opinion is through psychological tests. Especially in order to diagnose dementia of the Alzheimer's type, which is by far the more common, there are several tests one could use.

Starting from the most common, again, the Mini Mental State Examination (MMSE) is a relatively short test that focuses on all the dimensions of the disorder. It contains questions of orientation (such as the date), of memory (short term and long term), of calculation, of language fluency, and of executive control. It should not take more than fifteen minutes (tops!) and it provides accurate and exact results.
Another test that includes the questions of the MMSE but is more specific on the symptoms is the Addenbrooks Cognitive Examination Revised (ACE-R). This test contains all the questions of the MMSE (which is the quickest test of all), but elaborates more: it has questions concerning verbal fluency, verbal categorization, and tests also the visual- spatial abilities. The ACE-R takes more time to complete, but it leads to knowing more about which aspect of the brain has suffered most of the damage since it is more detailed than the MMSE.
Another way to test for the existence of dementia is by interviewing the caregivers of the person- usually a family member through a questionnaire called Clinical Dementia Rating (CDR). This is a large questionnaire divided in two parts: the greatest part requires for extensive information by the caregiver for all aspects of living and thinking of the person, and a smaller part adresses the person himself/ herself with similar questions. The CDR scale allows the psychologists to know whether the information they will receive from the person are indeed true, since they are already stated by the caregiver.
Those are by far the most common examinations used by psychologists, especially when combined with other scales, such us the Geriatric Depression Scale (GDS) to test for mood and behavior as well. Still, there are other tests used, such as the Frontal Assessment Battery (FAB) which is, as the name states, a battery of many tests combined to show specific results on the symptomatology, or the clock, where the individuals are required to draw a clock that points to a specific time.
Plenty of individuals from the general population may desire to be tested for dementia. The main category is the ones that actually suffer from the disease. Those are often brought for testing by relatives who have noticed the change, yet it is possible that the individuals themselves may become aware that something is up and request to be tested. Another group that often ask to get checked are those in their sixties who have recently been retired. These people have stopped many mental activities upon ceasing to work thus worry that it may be due to a possible disorder. Finally, a group that often gets tested is elderly with mood swings or a mood disorder. Symptoms of depression are common among the elderly, and they come along with cognitive deteriorations thus may be misunderstood as dementia.
Dementia, despite being a tricky disorder, is relatively easy to diagnose through tests, such as the ones mentioned above. This is because those are constructed in a manner that may reveal which brain area of the ones that suffer the damage, is actually affected for each individual, whether that is the visual- spatial, the verbal, or any other.
These tests are also very easy to score (especially the MMSE and the ACE-R), since each question is scored in a dual manner, where the person either gets the point- one for each question- or misses it. Then all the scored (thus correct) answers are added to the total. These tests are easy to conduct and provide effective knowledge on the state of the person, thus psychologists could devote some time upon learning them and use them when necessary.


Literature: DSM- IV, American Psychiatric Association; Dubois, B, Emre, M., Georges, J., McKeith, I. G., Rossor, M., Scheltens, P., Tariska, P., Waldemar, G., Winblad, B., 2007. Reccomendations for the diagnosis and management of Azheimer;s disease and other disorders associated with dementia: EFNS guideline. European Journal of Neurology; Harris, P. B., Keady, J., 2009. Selfhood in younger onset dementia: Transitions and testimonies. Aging and Mental Health.

Note: The tests can be found online, upon a quick search at Google. Here are some links:
http://cuzimage.com/image/oxford-medical-education-mini-mental-state-examination-mmse-oxford (MMSE)
https://www.pdffiller.com/en/project/63506873.htm?form_id=298845 (ACE-R)


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