• Scans – The person might be sent for a brain scan.
Depending on where they live, this may involve a
wait of several weeks. There are several types of
brain scan:
• CT (computerized tomography), CAT
(computerized axial tomography) and MRI
(magnetic resonance imaging) scans are widely
used. They all show structural changes to brain
tissue.
• SPECT (single photon emission computerized
tomography) and PET (positron emission
tomography) scans are less widely used. They
show changes in brain activity.
CT and MRI scans can identify conditions with similar
symptoms to dementia such as a brain bleed, tumor,
or build-up of fluid inside the brain. If the person has
dementia, these scans may show that the brain has
shrunk in certain areas. An MRI in particular may
also show changes caused by diseased blood vessels
in the brain, indicating stroke or possible vascular
dementia. A scan showing no unexpected changes
in the brain does not rule out conditions such as
Alzheimers disease. This is because in the early
stages of the disease the changes can be difficult to
distinguish from those seen in normal ageing.
SPECT and other more specialized scans can show
areas where brain activity (blood flow or metabolism)
is reduced. These scans are mostly used if the
diagnosis of dementia type is still unclear after a CT or
MRI scan.
To make the diagnosis, the consultant will bring
together all the information from the history,
symptoms, physical exam, tests, and any scans. The
combined picture will often allow a diagnosis to be
made. If the diagnosis is dementia, the consultant
should also be able to determine the type. In some
cases the consultant may diagnose mild cognitive
impairment rather than dementia, especially if the
symptoms are mild or could indicate depression.
Mild cognitive impairment is when the person has
problems with memory or thinking but these are not
severe enough to be diagnosed as dementia. The
specialist may then discharge the person back to
their GP and ask the GP to re-refer them if they are
significantly worse after a further six–12 months.
Sometimes the brain scan will not show any significant
changes and a further scan is arranged.
Preparing for End of Life
Because the end of life is hard to predict, it is best to plan ahead. You might want to start by asking yourself or a loved
one, “What is the best way to plan for the end of life?” The answer will differ from person to person. Some people want
to spend their final days at home, surrounded by family and friends. Others may prefer to be alone or to be in a hospital
receiving treatments for an illness until the very end. The answer may also change over time -- the person who wanted
everything possible done to prolong life may decide to change focus to comfort. Someone else who originally declined
treatment may agree to an experimental therapy that may benefit future patients with the same condition.
No matter how a person chooses to approach the end of their life, there are some common hopes – nearly everyone says
they do not want to die in pain or to lose their dignity. Planning for end of life care, also known as advance care planning,
can help ensure such hopes are fulfilled. To learn more about advance care planning, see NIH Senior Health – Planning
for Care.
A VOICE for Dementia (September 2016) newsletter is reproduced with permission from Positive Approach, LLC.
Use of Positive Approach ® copyrighted material limited to subscriber. To purchase subscription go to: www.teepasnow.com
Sources:
• Alzheimers UK – Dementia Diagnosis
• ALZ Association – Essentials of a Diagnostic Workup
• NIH Senior Health – Planning for Care
• Preventive Services Taskforce.org
Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontology : A Guide to
Assessment and Intervention 165-173, NY: The Haworth Press, 1986
Rose, K., Lopez, R., (May 31, 2012) “Transitions in Dementia Care: Theoretical Support for Nursing Roles” OJIN: The Online Journal of Issues in Nursing
Vol. 17, No. 2, Manuscript 4.
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Adviser a publication of LeadingAge New York | Spring 2017