Can neurologist tell what stage of Alzheimer's by initial exam?

I know that most of us initially are very interested in finding out what stage our loved one is in. But with more experience we come to understand that knowing the "stage" is not a helpful to a care plan as we'd hoped.

Let us say there was some simple blood test that would reveal that your loved one had just entered stage 3. Then what? That would tell you he was on his way to stage 4 -- but whether that will happen in two years or two months is still a mystery. And whether his stage 4 will closely match the standard description or be a very custom version is a big unknown.

So whether you can get a good professional guess or not, you still have to deal with one day at a time. Progressive dementia always gets worse, but it is not possible to predict how fast or slowly that will happen, and which symptoms will be the most intense.

Certainly you can ask the neurologist for an educated guess about stage.

As an occupational therapist, I can tell one's stage by the level of one's activity and the level of assistance they need from doing things like dressing, bathing, brushing their teeth. A Dr who is well versed could also make these estimated guess. Testing also depends on what some one will do, may do and can do.......all about motivation and abilities. However our daily activities are not so much.
Jeannne Gibbs is right about "what would you do", however if you had an occupational therapist do an eval they could also give you ideas of how to set up the environment for the best performance, as well as giving your loved ones the best supports so that she does not have too much or too little help. As we all know we get frustrated with too much or too little in our own lives. Good luck

Is there a more specific reason why you want to know the stage? Are you wondering what's next, or how to deal with a specific behavior? As the previous folks have indicated, knowing the specific stage gives limited information. If there is another reason you want to know, it might be more helpful to ask that question or those questions.

There is a reason to know what stage of dementia the person is in. Some people suffer from other mental conditions that cause them to seem as though they have more severe dementia. A person with depression or anxiety will be less responsive. As a result of the dementia diagnosis, the depression or anxiety will not be seen and treated for what it is and the patient will not partake in life as fully as they might if they did receive proper treatment for the conditions. I am not an MD, I am the daughter of such a person and must explain this to each new member of the medical staff, the rehab nurses, and the care facility.

Clarification: Obviously what is needed is a careful assessment that looks for other contributing conditions. Here, the family who knows the patient best needs to inform the medical staff of the personality of the patient. I have seen mom fool her rehab nurse and MD into thinking that she was near comatose. The MD looked again and more closely and agreed with me and had the order for rehab reinstated after the nurse determined that Mom was not a patient that could benefit from physical rehab. Got that corrected. It was one more win in a long series of events in which my input clarified the confusion brought on my Mom playing opossum.

SusanJMT, certainly an evaluation should try to distinguish between symptoms of dementia and symptoms that have other sources. I don't understand what this has to do with what stage the dementia is at?

Search Teepa Snows GEMS model on the internet, this might be helpful is figuring out where he is and what to expect.

Since the pace of decline is so different in different people, I'm not certain that the actual stage of the disease is terribly important other than in a general sense.

It seems to me that this is more of a medical model since in all of life it seems necessary to put labels on where people are in a certain scale.

If we do our best for our loved ones, no matter their stage, allowing them to be our guide (in may things that we do), the stage is just a vague guideline.

Caregivers note the decline, try - often with a professional's help - to see what can be done to help the person without causing undue frustration or anxiety, and then move forward with love.

I'm not discounting the value of numbers and stages for certain ratings, but I'm placing the individual above that.

Terrific input as always from the community.
Carol

Figuring out that my Mom jumped from Stage 4 to Stage 6 in three days after a fall and broken arm HAS helped me understand where she is. To see such decline quickly has been very disheartening but has allowed us to be more realistic is our expectations. She may retrieve some of her previous self care abilities but we are seeking help now in case she does not. The stage is just a guideline, but it is helpful to me. Just like following the stages of development for my children..

my husband having a hard time to talk to make sense want he talk and can't find the bathroom and seeing thing he think he at work

Watching my dad decline is heartbreaking, but I came to the conclusion that his stage really doesn't matter at this point. Every day he exhibits something new. What I do is treat the new problem. The end result is to make his life as comfortable as possible. It certainly isn't easy, is it, but if we have their best interest in mind and take it a day at a time, it seems to fall into place. So far anyway!

After my husband's first stroke, the neurologist explained his brain would function like swiss cheese: sometimes he'd initiate amazing conversations about our history, but the next hour he'd not be sure where his bed was. I've just learned to go with the flow. He's not pretending anything. I help him when I can. It's been almost 17 years now, and hospice is excellent support now.

How can you tell if a loved one is just trying to get attention by not remembering or if they are in some level of dementia? My mother-in-law can dress herself, eat, brush her teeth, wash her hands after bathroom trips but she doesn't know what day it is. She wants to know who is going to tell her what to do today, when does she take a pill (but yet know the time of day she has to take them). You can answer her questions but the 5 minutes later, she will ask the same question again. I think she is just playing us but I don't want to accuse unfairly.

Are you a neurologist? What stage your husband's dementia is in really is of more concern to you than him. He will digress at the rate his dementia progresses, and no one can determine that except with MRI's, and that is an unnecessary expensive test when the symptoms are present. Just love him for the time he has left. Start making arrangements for the final resolution. Best wishes!

Gpa013, you have pressed one of my hot buttons, lucky you.

Your MIL is displaying some deficiencies. Accept those. This is not "attention-getting" behavior. It is illness. It is not "manipulation" -- it is damage within the brain.

One of the really puzzling and confusing things about dementia is that it can be very irregular. Sometimes the person can remember how to tell time, and sometimes she can't. Sometimes he makes a sandwich when he is hungry and sometimes he forgets to eat. Some kinds of dementia are particularly known for inconsistencies, but all kinds of dementia have a degree of irregularity.

It is simply cruel to assume a person who is developing brain problems is "just playing us."

Jeannegibbs, Thank you for responding before me. You said it right on. Gpa013, you don't seem to have any knowledge at all of dementia. It seems to me you should find a place for your MIL to live. With your lack of knowledge and your bad attitude toward her, you may find you are yelling at her over something she can't control. That borders on abuse. Since she is not blood kin to you, you need to talk to your husband about moving her into a better environment for all of you. Please, don't feel bad about doing it, there is probably a lot of history with her and you. Read the other posts, caregiving is hard even under the best of circumstances. If he doesn't want to move her, let him take care of her 24/7 and you back totally out. She doesn't need to be yelled at for something she can't help.

Jean begins...thanks for your response. This is why I'm here - to learn and understand what is going on with my MIL's actions. Her PCP did the initial testing in office and the results were a high score, meaning she did well at recalling answers to the questions asked. I've been reading a lot of material on the subject of dementia. It doesn't look like the journey will be pleasant. I'm trying to locate as much knowledge and support as possible. I apologize if my question offended you.

GPA013: Mom would call me no less than 20 times a day at work to ask me the same three questions. Mom had nothing to keep her mind occupied, didn't want to engage in any social activity, and so obsessed on things that made her anxious. Anxiety medication made a huge change in her anxiety-driven behavior. This might not be the same situation that you have but worth considering.

WOW... I thought this place was a support site! It seems I've been judged to be a mean person. I'm not yelling at my MIL or doing any kind of abuse. I'm here asking questions to try and understand this disease from others who have experienced it. My husband shares the same concerns I do, we are both trying to cope with the situation. I think my question has been taken out of context.

The stage of the disease isn't of much use beyond a notation in a medical chart. It can't predict how rapidly or slowly the dementia will progress.
In fact, more current methods focus on characteristics rather than numbered stages. Google "Teepa Snow" and read about her Gems model for characterizing levels of dementia and (more importantly) how to adjust to care for someone at each level.

Thank you "Isn't Easy" will follow your suggestion.

I agree with Vicky123. My sister & I are our parent's guardians. Our father has dementia (diagnosed over a year ago - but we think he's had it much longer than that.) Parents live in an Assisted Living Community, close to my sister (who checks up on them at least once a week). I live out of state but fly in every 3 months to visit our parents, talk to his doctors, and see how hes getting along. Dad is doing ok at the AL, but ONLY if Mom is there with him all the time. Mom is in denial most of the time about how bad he is deteriorating, so we MUST rely on his doctor's testing & assessment. My sister alerted me that Dad was having a difficult time recognizing his adult granddaughter & great grandchildren & other relatives he sees quite often. This has motivated us to ask his Doctor if Dad has moved over to Alzheimer's. He will be tested next month. This information is important to us to help make decisions moving forward. Without a professional assessment, we don't feel able to make a decision for him moving forward, and determining what Phase he may be in will be helpful to help Mom come to terms with her denial (as they respect the doctor's assessment).

Gpa013 - I think that might be your grade point average if you think your mother-in-law is "playing with you". No one wants dementia. No one wants to put relatives through hell waiting for them to die. Believe her. Trust her. And above all, stop being judgmental about any of her symptoms...

So true all, my Mom was in stage 7 for 5 years, so stage definition doesnt matter.

In all fairness, the behavior of our Loved One certainly can look like it is deliberately designed to drive one mad. It takes a while to get used to reciting, "He can't help it. It's the disease." I can promise you that repeated questions in particular are never part of any game. I was once on medication that inactivated my short term memory. It is real, frustrating, and terrifying!

Mary Kathleen and Ferris, you came down on Gpa013 a little hard. Never ascribe to malice what can be explained as ignorance. Give the poster the benefit of the doubt.

@Hunter2, you are having a hard time! When he can't find the bathroom, some people paint the door red, or some bright color, so that he can find it. People with dementia can see things that aren't real. They can also daydream, and think that the dream is real.

Tell him that you love him and you will keep him safe. Tell us more about your situation, and we might have some good ideas.

You need a Neuro-Phychiatrist. They can give them very simple tasks to do. I remember my mother's took 2 hours. It needs to be scheduled early in the morning when they are at their highest level of function. They can tell you exactly where your love one is at what stage. Before having the test done try to find someone who is a Geritrician or has experience in Geriatrics. They need to have their meds checked and possibly be slowing weened off some. They will need blood work. They can have deficiencies which can be fixed. It is a process but, it may help them function at a higher level.

Dementia is present 5 years before it is diagnosed.

Gpa013, I wasn't "offended" by your question and don't know enough about your situation to be judgmental. I am glad to hear you are information-gathering.

I think the "is she manipulating us" is such a hot button for me because for 10 years I took care of my husband with LBD. A core characteristic of that kind of dementia is frequent and significant fluctuations in cognitive levels. I have heard heart-breaking stories in my local support group A care center accused one man of "trying to get attention" because he couldn't do something in the afternoon he could do in the morning. They thought tough love was a suitable approach. OMG!! And we had a young couple that came to a few meetings when her mother went to live with them. But they just could not get past the "why is she trying to manipulate us like this?" question to benefit from the experience of the group and they dropped out.

So whenever I see that attitude or questions I try to nip it in the bud. So good for you, Gpa013, for trying to learn all you can about this very strange a puzzling disease.

To those who tried to help me...thank you! This is hard on our family, not just me. Certainly, no one wants to have any kind of illness and I'm finding out dementia is a horrible disease that robs someone of their life and is very sad to those that have to watch their loved one slip away. I've been made to feel ignorant and all but accused of elderly abuse by a few on this site but I will keep asking for your help. May God bless you all.