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Connecting the Dots Means Early Detection in Dementia

One of the other casualties of this extended quarantine is the cognitive consequences of less social interaction and less intellectual stimulation…what we call the “Activities of Daily Living.”  If you have an older loved one with whom you still maintain at least some contact by phone or ZOOM, are you keeping track of their mental acuity?  Allow me to put one more tool in you tool kit for monitoring you older loved ones.

If you sense a disorientation or confusion that was not there before or maybe it seems to have elevated in frequency or intensity, it’s important that you get a professional to weigh in.  First, be prepared to help the provider who may intervene on your loved one’s behalf by giving your best understanding of the timeline for the onset of this new cognitive issue.  It used to be that we would look to perhaps a urinary tract infection for relatively sedentary older adult who has become more conspicuously confused within a short time – days or weeks versus months.  A cognitive decline of such short duration can simply be delirium, and it can be cleared up as easily as the underlying infection can be cleared.  That is, if it is a urinary tract infection, but let the professionals make that diagnosis.

If the decline has been over months, what seems to be most conspicuous about the change?  Is it confusion about:

  • Dates and times?
  • Location?
  • Short term recall of names or objects?
  • Simple math?
  • Name retrieval of objects or people?

If so, the health care provider or a referral to a neurologist may result in a Mini-Mental Exam.  It’s a straightforward 30-question test.

And there is a relatively newer test called the Montreal Cognitive Assessment that is as long, but it also has the ability to test for cognitive abilities like:

  • Language and communication skills
  • Short term memory
  • Attention and concentration
  • Spatial and temporal orientation.

This last one literally does call for a visual exercise in connecting dots in a systematic way.  And this is the important part – if your loved one’s provider is assessing that individual’s cognitive ability, the Montreal test is better at catching a problem early, and it is more sensitive to cognitive impairment owing to a variety of conditions such as Parkinson’s, vascular dementia, Huntington’s, brain tumors, trauma or multiple sclerosis.  But neither of these tests will actually diagnose the specific underlying cause among all of these potential conditions to which we can also add Alzheimer’s.  That would take a full-blown neuro-psych evaluation.

The key takeaway is that the “new test on the block,” the Montreal Cognitive Assessment, can detect real cognitive issues earlier and across a wider range of underlying conditions.  So, if you do communicate any cognitive concerns to your loved one’s provider, be aware that all tests are not equally capable, and early diagnosis is better than too late if you want to have an optimal outcome.  During this time of quarantine, it is important to be as vigilant as we can – albeit at distance.

Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.


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