Dementia assessment; how long, how in depth?

Dear Longhaul,
I am a patient diagnosed 2 1/2 yrs ago with Dementia/Prob early onset ALZ. I first notice memory loss in Feb 2011. Doctors kept blowing things off until I was summarily fired from my job that ended a 38yr career. Then it was oh boy, we better look further. MRI showed evidence of some tangles, mini mental not great, went for a Neuro/psych eval which it took over 2mos to get an appointment for and another month for the results. I am now 59yrs old.
The tests took about three hours to complete. The tests were very frustrating. I had provided a copy of a Neuropsych exam I had in 1962 at the age of 3 and diagnosed with Severe Cognitive Impairment. I was told, I'd never hold a job, drive a car, manage a bank account. Fortunately for me my parents were smart enough to go about getting me some specialized tutoring.
I regret not having asked my DW to come along for the results with the Neuropsych doctor because what he told me verbally and what he told me in writing were two completely different reports. I think when he went to put it in writing he decided to play CYA. My Neurologist said it was clear he did not bother reading the report from 1962 because the results were the same. Nothing new that surprised her, but enough detail she felt comfortable prescribing Aricept which took about 6mos for it to help clear out cobwebs, and renewed my interest in reading and my volunteer activities. My Neurologist from the beginning wants my DW to come along for each appointment so she can give her perspective regarding declines etc. Those of us that have Dementia need to have someone onboard that can advocate for us, and can validate or dispute claims made by us, the patients when we are declining.

There are other medical problems that can mimic dementia. Treat these problems and the false dementia goes away. A partial list: low thyroid, vitamin B12 deficiency (amazing turn around in one relative when treated), prescription drugs, interaction between 2 or more prescriptions, depression, If dementia is diagnosed early, drugs can slow the progression. Knowing what is coming is very useful for planning and getting legal documents in place while there is still time. The first test is a mini mental status exam. You can see this and take it online. I find this test very easy. I could probably have a significant level of dementia and still get past this test. Another test is to ask the person to draw a clock and put the hands on for a time, say 10 minutes past 5. I was shocked by how bad my dad was at this. There should be blood tests for the above mentioned problems and an MRI to rule out a tumor, stroke etc. (Doctors make a diagnosis by ruling things out.) More extensive testing with an expert would go as follows. There is an interview where the doctor finds out about the person, their interests, what kind of education they had and the work they did. The doctor is learning things just by seeing how the conversation goes. He is also getting an idea about what testing to do. For example, if the patient has a PhD in math then they should know the cube root of 27, (answer 3). but with a 9th grade education perhaps adding 25+10 (=35) would be a more suitable assessment. There are different tests to assess different parts of the brain. Those of you who can't count backwards by 7 should consider practicing this as well as pushing yourself to learn new things. This sort of mental activity may delay the development of dementia. Best wish to all of you caring for older people, take good care of yourselves.

Longhaul,
My mom's assessments took maybe an hour or two, and gave me and my brothers a base line. The tests are not painful or invasive, and can help you if you need to get further assistance.

a different take here, but my dad, who died from ALZ in April at age 93 was only diagnosed two years earlier at age 91. I felt a bit ripped off as I heard people lived longer after diagnosis than that, though I guess the older you are the less time you have.

I am guessing he could have just as well been officially diagnosed a year or two earlier, as he did have minor memory issues we just passed off to old age. In a way I am glad they did not diagnose him as once he was diagnosed, you sort of feel you are on the clock. I am not sure diagnosing him earlier would have changed anything, unless the dementia was due to something else like UTI, mini stroke, or something. Once he was diagnosed was when I began feeling bad.

The best way to get a clear answer on this is to call your dad's doctor and ask. There are different types of memory evaluations. Also share with them your concerns. They want everyone to be as comfortable as possible with any assessment process.

I do not have a problem with unbelieving relatives. So, what is the reasoning for these tests? DH's gerontologist didn't mention them. His PET scan showed the brain shrinkage and plaques and tangles. He didn't tolerate Aricept well. He is 86 with a pacemaker. If I asked for these tests, what is the purpose? I guess, in other words, why put him through it? If it is just to establish a baseline, I don't see the need. What will happen will happen. As they say, if you have seen one case of Alzheimer's, you have seen one case. I will just have to deal with it as it comes. This forum and group are the greatest and I have already had so much help from all of you.

A Pet Scan is a good start. My SIL, just diagnosed with the worst case of dementia, is getting this test promptly. She has already had an MRI and it wasn't good news. There's another one, too, called a SPECT scan.

A neuropsycological evaluation by a Neuropsychologist (PhD, not an MD) would be a good next step

My mom's family doctor referred us first to a neurologist. It was the neurologist who sent us for the lengthy psych eval and neurological testing, several hours in length and parts of which my mom refused to complete. This was back in 2008. It's been a very slow downhill course. She's been in a regular nursing home now for over a year, in a wheelchair, can still carry on conversations that don't make much sense. She eats and sleeps well, no longer is combative, no major changes this past year. She's 84. Her aunt lived with Alzheimer's till age 90. Three of her first cousins (this aunt's children) died in their 50s with Alzheimer's. I can't imagine another 6 years ore more of this but realize it could happen.

My mom had an all day testing done at Henry Ford medical Detroit.

Under the guidance of three forensic psychiatrist when did the testing they all interviewed her and then they all went over the test claims she could handle her own Financial medical, and legal but since she already was into Guardianship and already claimed her incapacitated without any evidence they denied the test it was covered under her insurance and it says when your petition for guardianship that you have a right to choose who you want to test you if you can afford it it's covered under her Blue Cross and it was quite you know it was over $1, 000 quite detailed.

Wayne County Michigan Judge asked the the opinion of a PhD who said it wasn't what he was looking for.

The Guardian header committed into Botsford psychiatric ward and after being kidnapped from her house by the police.

The head doctor said after 9 days my mom didn't need a guardian at that time. A lot if medical test we're done but the Guardian for profit didn't use any of those Medical records when the Guardian put my mom on Lexapro and Namanda and her Heath issues should never been on the drugs. They also cause confusion dizziness falling everything to make her look like she had dementia and it caused my mother chronic kidney failure.

They have daily living mini test you can find on line but it should be given by a forensic psychiatrist they're not supposed to go against them but the court does what they want so it's best you have this testing done way before there's any issues as a baseline.

None of medical records testing has been entered into my Mother's Records per her past Guardian when she responded to a grievance for the attorney grievance port.

I don't have compancy issue but I can't count backwards from 100 by 7.

My wife was diagnosed with Alzheimer's/Dementia and I read all I could about it. What I read was disturbing it said folks can suffer from this for 15 years or more. I just thought she/us have to suffer for that long? Well she passed away about one year later from other problems.
The main reason I am writing this is, I don't think there is one fit all answer. When you see one Alzheimer's person you have seen ONE. What my wife went through your loved one may never go through. There are general symptoms but just so many other things that take place unique to that person. Now I am not a doctor or professional but just someone that lived through it. It's was not easy or fun.
Good luck and may God bless.

My mother’s path started with the mini exam with the PCP. Followed by a CT scan showing moderate brain shrinkage. Diagnosis was ALZ. Namenda was started.

Two years later I brought up the alarming loss of words my mom had and the PCP agreed and referred her to a neurologist. That was a 2-1/2 hour “exam” which was more conversation than actual testing. Also saw a social worker prior to seeing the doctor. Outcome: new mixed diagnosis. Primary Progressive Aphasia and ALZ. Lexapro was started for some behavior issues.

Two years passed and mom is now in a Memory Care facility. Increasingly combative behavior was out of the range her PCP was comfortable prescribing for so referred to a geriatric psychiatrist through the hospice palliative care program. New diagnosis: Frontal Temporal Dementia with PPA. Remeron has been added with fantastic results in smoothing out mood swings.

So it’s been an evolution in care for my mom. Each step building on the previous.
I would say the PCP is seeing something that you might not. Start with the neurologist and get the second opinion. Once you get started it’s not as intimidating as it seems now. I have steered my mom through this and have encountered very compassionate people at every turn. Good luck!

Interesting how different all these answers are! We went through two psych evals, both with the same neuropsychologist (the only one in town, as it is with many types of specialized medicine in my area). My mom’s interview and 3 hours of testing resulted in a diagnosis of dementia of unknown type, and she is still in about the same state now as she was then, maybe declined by 15%-20% over the past several years. My dad’s, a few years later, unfortunately resulted in a diagnosis of Alzheimer’s. Over the past 5 years his mental status has worsened considerably, but his diagnosis has opened treatment, housing and assistance doors for our family that have been invaluable. I’m a little envious of those who report getting a full analysis over two days by a coordinated team. We had to use separate appointments with a neurologist, a neuropsychologist, and a psychiatrist (for meds), as well as the social worker at their PCP’s office and the Area Agency on Aging, and there was a lot of exhaustion and confusion along the way. Personally if I had it to do over again I’d start with the AAA, just because their housing/caregiver issues turned out to be paramount in the end.

You usually see a neuropsychologist and the testing can last 4-6 hours with a break. It can be frustrating and exhausting for your loved one but it definitely will tell you where you are with your dad as far as cognitive decline. It shocked me but it will validate what you thought or the doctor thought. I knew my husband was having some forgetfulness and he was diagnosed with Mild cognitive Impairment which can or cannot lead to Alzheimer’s; unfortunately his was eventually diagnosed as Alzheimer’s. Why it helps is you can start NOW to prepare and research what meds to get him on etc etc. and educate yourself in how to help him. Good luck!

My Dad had this done last year when doubts about his cognitive functions were raised.
It is an extensive test that begins early in the morning lasting all day. They said to plan for 8 hours, we were there about 6. There are 2 breaks as well as lunch.
This extensive testing, done by a neuropsychologist, was invaluable because of two siblings who live out of state who believe Dad only has short term memory issues. It has also been helpful when needing additional care for him to have that test as 'proof' of the level of his dementia.
A PCP can perform minimal in office testing that may give a general idea of what cognitive issues are present. However, this test is above and well beyond giving in depth and definitive diagnosis for those who doubt, both family and other practitioners.
The neuropsychologist who performed my Dad's tests was amazing. He spent 45 minutes in a phone consult with me to go over the results, offering me a wealth of information and what to do next. He answered my list of questions and didn't rush me like I've felt with others through this painful journey.
I encourage you to pursue this test if you are facing resistance from anyone. It is irrefutable information and will save you time and effort in explaining symptoms and seeking proper care for your loved one.

Good morning long haul. Several years ago my father had a psychological exam. He was diagnosed with dementia before the exam based upon th clock test and The Who’s the President, etc test. The clock test is commonly used to diagnose dementia. At the time my dad was having short term memory issues bout minor.

The psychological test was very detailed and time consuming. They asked me questions for about 15 minutes and then they asked me to leave. My guess is it took a couple of hours. My dad felt like he was in a college exam on a subject he knew nothing about, did not study for and probably didn’t do well.

i received a report which was lengthy, overly wordy and concluded my dad had serious psychological problems. The Dr never mentioned the report and neither did I and my dad did not even recall it.

I guess i would would say make sure your Dr explains in layman’s terms why he is ordering the test, how long it will take, how will it affect the treatment and what would be the affect of refusing the test, i.e. what if he said no. Find out what u can by googling. For me, a bit traumatizing with no benefit as far as treatment results for early dementia.

Goid luck, Pam

I assume it will be along the lines of what my wife had. A Neuropsychological Evaluation. It's a 30-45 interview by a psychologist and then a battery of tests and questions which basically measure learning and memory function, in my wife's case it analyzed dementia.

My mom's situation was similar to others who've responded. It took a year of persuasion to get her to her PCP for a complete physical. At about age 83 all her physical tests, blood work, etc. were fine, but we were seeing lots of signs. Short term memory loss, difficulty finding words, not remembering people's names, repeating the same story multiple times in a 10 minute phone call.

The PCP advised we get an assessment from a neurologist or the local "Center for Healthy Aging". We did both. There was a 2 month wait to see the neurologist and 4 months for the other.

The neurologist did some type of brain scan (CT?, not MRI) and spent about an hour with her. The Center for Healthy did a much more extensive assessment which took about 4 hours. They watched her walk and move then gave her oral and written exams. She was seen by 3 or 4 professionals led by a gerontologist and given a very thorough evaluation. Then they met with her and family members a couple of weeks later.

Mom's diagnosis was mild-to-moderate cognitive impairment. With no evidence of any other specific cause they said it was likely to be Alzheimer's. That was three years ago and it's clear they were correct.

I encourage you to proceed with the most thorough analysis you can find in your area. They can distinguish between general age-related memory loss and Alzheimer's or some other specific forms of dementia.

Best wishes as you head down this path.

If your doctor is looking for an evaluation done by a Neuropsychologist it can take up to 2 hours. There is also another program called Geriatric Assessment with a team of Geriatrician and Social Worker which can can take up to 1-1/2 hrs. Both are very in depth which is what you want when dealing with memory loss. When setting up the appointment ask how long and what is involved. The more information you can supply regarding the memory loss, symptoms and onset the better. it's like putting together the pieces of a puzzle. Good luck

I'm assuming this isn't the mini mental health evaluation, which is about ten questions and can be administered by PCP or neurologist. There is also a 6-7 hr verbal/written neuro-psycholgical exam, usually given by a PhD psychologist. This longer exam can identify the likely type of dementia and rule out others. My late husband got a diagnosis of "moderate dementia, probably vascular, with results not consistent with Alzheimer's". Of course he grabbed onto that "not consistent with Alzheimer's" and totally ignored the "dementia, probably vascular" part. But the information I got was very valuable in making plans to move closer to our family in another city. I was told that he was at extremely high risk of a major stroke, and indeed within 15 months he had a stroke that killed him--in spite of taking meds to prevent it.

Longhaul, call back the PcP and say " I'm sorry, but I have no idea what you mean by a "psych exam" for my dad. Can you give me some direction as to what kind of doctor I need to make an appointment with and what I tell that doc what you are looking for?".

You might also just speak to the receptionist because the recomme ration is likely in the chart.

When my mom was living with me, I saw before anyone else did the memory loss, the irritability, the difficulty replying to questions, etc. Her doctor at the time performed mini mental status exams , which she passed, each time she saw him so he refused to prescribe any medication to slow the progress of the dementia. Then, we were referred by him to a gerontologist, who sees her a few times a year. It was she who convinced me that mom needed 24/7 care.

Is your father being referred to a geriatric psychiatrist, neuropsychologist?

My mom's neurocognitive assessment was conducted by a neurologist, a neuroosychologist and a psychiatric nurse. Testing and evaluation was accomplished over two sessions,., each lasted about 3 hours, so 6 hours in total.

It was very thorough and we got a lot of very useful information.

Most useful was having a professional tell my brother and SIL that mom was not "fine" and not "doing this to herself".