In my little world here in Delray Beach, Florida I have learned a harsh lesson -- it is very difficult to diagnose mild cognitive impairment, dementia, and probable Alzheimer's. My first experience was with my own mother......
Bob DeMarco Alzheimer's Reading Room Editor
I knew something was wrong with my mother. I knew it. When I would mention some of my concerns to family and friends they would usually conclude -- she is getting old. When it first started to really bother me my mother was 86 years old. Her friends that saw her everyday would tell me she is doing great. Her doctor of six years didn't see a problem.
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I did know her behavior was undergoing subtle changes. She talked about money incessantly, she complained about being bored incessantly. She started scrapping her feet on the ground. She said things that lead me to believe she was feeling insecure, maybe fear -- these were very different than what I heard her saying in the past. After my mother was diagnosed with dementia her friends refused to believe both the diagnosis and me. When she would talk to family and friends that lived far away they would usually say --she sounds great. She did sound great. She could still drive, go to the store, and play bingo. What they didn't see was how her behavior would often turn erratic. I invited all of them to come live in the front row for a few days -- they passed.
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The time came when I decided to come and spend some extended time with my mother and try to find out what was happening. At the time, you could put everything I knew about Alzheimer's and dementia in a thimble. It took a few months before I finally started to understand the problem. It took four doctors to get to the bottom of the problem. None of the people that were seeing my mother on a daily basis saw a problem. People in an early stage of dementia are very good at disguising the problem. They can laugh and change the conversation when you ask them questions about memory, or the ability to go here and go there. For me, it was the changes in behavior, the meanness, and the inability to walk more than a block that tipped me off.
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If a person suffering from dementia gets lost or starts having problems driving, you will never hear about it. The last thing an elderly person wants to do is lose their independence. One of the biggest symbols of independence is the drivers license. Trying to get that drivers license is like trying to get a steak out of the mouth of a bull dog.
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After I had been hear a couple of years, I learned some interesting things about my mothers behavior. She drove her car over a concrete abutment, through a hedge and hit a tree. She then drove the car around some trees, over a sidewalk, over the lawn, and put the care in her condominium parking space. She didn't tell me, my brother, or my sister. When I first learned about this her friends were laughing telling the story. They were impressed by the fact that she actually got the car back into her space. They did not see it as an indication that maybe she shouldn't be driving -- or worse. Her friends, still friends, also forgot to mention that they stopped inviting my mother to their lunch time outings to restaurants because she constantly complained about money. When I asked them years later, when I first learned about this, if she had always done this -- they said no. In other words, her behavior had clearly changed but it had no impact on their view of her health.
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If you live far away from your parent and they are over 80, there is a good chance you could end up in the same situation I found myself in six years ago. Here are few things you can try to spot mild cognitive impairment, Alzheimer's or dementia at an early stage.
Clock Drawing Test
The Clock Drawing Test is a well known, frequently used screening tests for dementia. Patients are asked to draw a clock with the numbers in place. They are then asked to put the hands in at a specific time -- like 3:45. A perfect clock would score a ten. No problem. If the person cannot draw the clock or if it looks abnormal they could fall into the category of "probably" suffering from mild cognitive impairment or dementia. Special note: if they can't draw the clock it could also be any of number of diseases that present as dementia. They need to be tested by a specialist. Here is one method of clock scoring:
I suggest you also read these this article carefully -- The Mini-Cog Test for Alzheimer's and Dementia
The Smell Test
Research indicates that loss of the sense of smell is an early warning sign of mild cognitive impairment, dementia, and probable Alzheimer’s. The beta-amyloid plaques that ultimately destroy memory and other cognitive abilities accumulate first in areas of the brain that are responsible for perception of odors. The odors/smell used in the testing were banana, black pepper, chocolate, cinnamon, gasoline, lemon, onion, paint thinner, pineapple, rose, soap and smoke. Participants who scored below average were 50% more likely to experience mild cognitive impairment -- an early warning sign of Alzheimer's disease. I want to be clear -- this might indicate -- early dementia. If you decide to try this and the results seem suspicious get to a specialist to determine the nature and extent of the problem. This test alone is not sufficient to make a diagnosis. This test can be used as a warning sign that might help you get a jump start on a future problem.
You can read an example of this research here -- Inability to Smell Odors Might be an Early Sign of Alzheimer's
Quick Tests
If a doctors suspects mild cognitive impairment or dementia he might give a person several tests that examine specific cognitive abilities. To test language ability, the patient will be asked to name as many items as possible in a given category, such as fruits or animals. Naming fewer than 10 items in one minute could suggests slow mental functioning.
Counting backwards by sevens, spelling a word backwards and forwards, or listing the months of the year backwards are tests of working memory and attention.
Note: I would have tried the months test first had I known about it.
Listening to a list of words and reciting them back is a common memory test. A person without memory problems should be able to remember at least three words. Best method is to say three words, then ask a question or two, and then ask the person to repeat back the words. If the person cannot remember two of the three words its time to get worried and ask for some serious memory testing from a doctor-specialist.
Warning to anyone that read this article. These are screening tests, not diagnostic test.
I offered this article to help those that might be worried, or have parents over 80 that seem to be acting "different". These tests are worth the effort.
They are particularly useful if you live at at distance from your parent and are unable to observe them for an extended period of time.
I want you to know that if I had been aware of these test, it is likely that I would have identified the problem with my mother sooner. The amount of angst and worry I was feeling prior to my move to Delray Beach was enormous. It got to the point where it was bothering me daily. It is easy to fall into a state of denial or to put off the inevitable when dementia strikes.
However, I can tell you from experience people that fail to take action often suffer from feelings of guilt and remorse, something they might carry with them for the rest of their lives. On the other hand, taking action early can make an enormous difference in the life of the person suffering from dementia or Alzheimer's disease. It will also make an enormous difference in your life.
Bottomline, if you take action early there might be a treatment that comes along that slows or stops the progression of the disease. To those that tell me this is far away in the distance future I say.... My name Bob DeMarco, I am an Alzheimer's caregiver. My mother Dorothy, now 93 years old, suffers from Alzheimer's disease. We live our life one day at a time.
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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. The Alzheimer's Reading Room is the number one website on the Internet for news, advice, and insight into Alzheimer's disease. Bob has written more than 950 articles with more than 8,000 links on the Internet. Bob resides in Delray Beach, FL.
Original content Bob DeMarco, Alzheimer's Reading Room
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