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Brain health and screening for dementia

We were delighted to welcome Dr Zahinoor Ismail MD FRCPC of the University of Calgary to give a talk on brain health and screening for early dementia detection last month.

 

The audience at The Manor Village at Garrison Woods were treated to an in-depth analysis of cutting edge research and examples of best practice. We wanted to share some of the key points for our non-medical readers here on our blog, to help family, friends and workplace colleagues to spot the early signs of dementia.

 

 

Cognitive dysfunction and functional impairment

 

Cognitive dysfunction can translate into functional impairment that we may be able to spot on a day to day basis, particularly in the workplace. Dr Ismail identified four key areas and noted how impairment might show itself.

 

1. diagram of brain differences between normal and alzheimersExecutive Function

 

  • Inability to prioritize
  • Lost ability to innovate
  • Poor decision-making
  • Procrastination

 

2. Attention

 

  • Doesn’t want to talk
  • Cannot follow through tasks
  • Poor quality work

 

3. Memory

 

  • Misses appointment
  • Does not meet deadlines
  • Overall activity are limited

 

4. Psychomotor

 

  • Less vigilant
  • Slow to initiate or complete tasks
  • Makes errors and typos

 

 

Types of dementia

 

Dementia is an umbrella term which covers many different forms. Alzheimer’s Disease (AD) is the most common type, accounting for 60-70% of all cases. Other more common types include vascular dementia and Lewy Body dementia. Some patients may suffer from mixed dementia, where AD overlaps with other dementia types.

 

 

How Alzheimer’s Disease affects the brain

 

As shown in the diagram below (slide 9), Alzheimer’s Disease reduces the brain mass in key areas, including those responsible for memory and language. Furthermore, dementia affects the daily lives of those with the disease in multiple ways, from loss of motivation and drive to agitation, anxiety, mood swings, and socially inappropriate behaviour. These are known as Neuropsychiatric Symptoms (NPS), or the behavioural and psychiatric symptoms of dementia (BPSD).

 

 

Mild Behavioural Impairment (MBI)

 

Quoting his own paper on “Neuropsychiatric symptoms and early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment” (1), Dr Ismail shared the changes in behaviour or personality in the over 50s that might raise concern if they persist for longer than six months:

 

  • Drive/ Motivation
  • Affect
  • Impulsivity
  • Social Appropriateness
  • Thoughts/ Perception

 

He stressed that formal psychiatric illnesses and pre-existing dementia should be ruled out first.

 

By using cognitive screening methods, an early diagnosis can help explain changes in behaviour, mood, cognition and function. early diagnosis also allows caregivers, family and patients themselves to plan ahead. However, he also stressed that screening doesn’t necessarily equate with a diagnosis of dementia.

 

 

Ask the family

 

Many screening methods ignore the people who probably can spot changes the best – family and caregivers. As Dr Ismail says, “A common cause of diagnostic error is to ignore the family.” Patients themselves may not be aware of their own decline, or of the safety issues they pose.

 

This is particularly important when you consider the statistics surrounding home care of those with Alzheimer’s Disease (AD):

 

  • 87% of people with AD are taken care of at home by family members
  • 60% of caregivers are women
  • 50%+ of caregivers are children
  • 11% of caregivers are grandchildren
  • 6% of caregivers are spouses
  • The average age of caregivers is 48
  • 250,000 American children aged between eight and 18 provide unpaid care for someone with AD

 

 

The ideal screening test

 

Dr Ismail outlined what he considered to be the key elements of the ideal screening test:

     

  • Brief in duration
  • Acceptable to patients
  • Insensitive to confounding factors such as culture, language and education
  • Simple to administer and score
  • Sensitivity and inter-rater reliability
  • Cover a broad range of cognitive functions

 

In our next blog in this series, we’ll examine the various tests used, and their benefits. Stay tuned!

 

 

Help when you need it

 

If you’re finding it difficult to care for someone with memory impairment, AD or other forms of dementia, call us. The Manor Village Our Hearts Memory Care lifestyle provides a safe and secure environment for those residents requiring guidance in a structured and/or supportive environment. We can also offer expert respite care to give family caregivers a well-earned break.

 

 

 

NOTES:
(1) Alzheimers Dement. 2016 Feb;12(2):195-202. doi: 10.1016/j.jalz.2015.05.017. Epub 2015 Jun 18. https://www.ncbi.nlm.nih.gov/pubmed/26096665