Every year in clinics across the country, thousands of people are asked to draw the face of a clock, repeat lists of words and complete seemingly simple tasks. Many leave with life-changing news: They have cognitive decline.
These quick assessments are just the beginning of the journey, but a diagnosis doesn’t erase who your loved one is, or what’s possible for them while having dementia.
Here’s what you should know after your loved one’s dementia screening.
[READ: 8 Health Problems That Can Mimic Dementia]
What Is a Dementia Screening?
A dementia screening is a series of tests to determine if someone has dementia. Dementia is a general term for declining memory, thinking and problem solving. The main purposes of a dementia screening are to rule out underlying conditions, determine the type and severity of the dementia and to determine if the condition is treatable or reversible.
Because dementia is a general term for a group of conditions, it includes many diagnoses, such as Alzheimer’s disease or Lewy body dementia. To determine the specific type and to guide treatment, a medical provider will perform a comprehensive dementia assessment. Sometimes, when people talk about dementia screenings, they are referring to just the cognitive testing portion of this assessment, and other times, they are referring to the entire group of tests.
[See: Preventing Dementia and Alzheimer’s: 8 Habits to Reduce Your Risk]
Cognitive testing
There are several reliable cognitive tests to help diagnose dementia. Cognitive testing is also a key part in determining the severity of the dementia.
A neuropsychologist may also do a comprehensive battery of testing that could take many hours to complete, says Dr. Mill Etienne, associate professor of neurology and medicine at New York Medical College in Valhalla, New York.
[READ Rapidly Progressive Dementia: Reasons for a Sudden Worsening of Dementia Symptoms]
Full medical history and assessment
To rule out other causes of dementia and to determine dementia severity, a provider may arrange for the following to be completed:
— A psychiatric evaluation to rule out depression or other mental health conditions that can mimic or worsen cognition
— An evaluation of current and past medical history to identify any conditions that may contribute to cognitive decline
— An evaluation of current and past medication use to check for drugs that may impair thinking, memory or functioning, including substance use
— A functional assessment to determine how cognitive changes are affecting everyday life, such as driving, getting ready in the morning or managing personal finances
Labs
A provider may order lab tests to rule out other conditions that mimic dementia symptoms, or to check general health. These may include:
— Complete blood count
— Complete metabolic panel
— Vitamin B12
In rare cases where a provider suspects an inherited dementia, they may order genetic testing. However, most cases of dementia don’t have a single genetic cause, and the genetic cause rarely impacts the treatment plan.
Imaging
The most common imaging tests for dementia screening include CT, MRI and PET scans.
“If the person is able to get an MRI, I generally prefer that over getting a CT scan so the patient won’t have to be exposed to radiation,” Etienne says.
Imaging may support a dementia diagnosis, help rule out strokes or brain bleeds or assist with determining the type and stage of the dementia. Early dementia may not be seen on imaging.
A provider may recommend imaging if your loved one:
— Had a recent head injury
— Takes anticoagulants, such as warfarin
— Is under the age of 65
“A PET-CT may be done to look for amyloid plaques in the brain that accompany Alzheimer’s disease — especially if new anti-amyloid drugs are going to be used,” says Dr. Paul Bryman, an associate professor of medicine at the Rowan-Virtua School of Osteopathic Medicine in the Department of Geriatrics and Gerontology in Stratford, New Jersey. Bryman is also the medical director of United Methodist Communities Collingswood, an assisted living community in Collingswood, New Jersey.
[READ: Alzheimer’s Disease: Could Deep Brain Stimulation Help?]
7 Steps to Take After a Dementia Screening
Receiving a dementia screening is overwhelming for everyone. In fact, many people decline testing for dementia or decline follow-ups after they are found to have cognitive impairment. In many cases, this is because of a very justified fear, says Dr. Adel Aziz, a cognitive and behavioral neurologist at JFK University Medical Center in Edison, New Jersey.
“The layers of fear are profound and legitimate,” Aziz explains.
But there is a way forward. After a dementia diagnosis, here are steps you can take to feel grounded and prepared.
1. Understand the diagnosis
Do you feel like the evaluation was comprehensive? For example, if cognitive testing was borderline, and a provider didn’t take a thorough history of your loved one’s condition, ask for an additional visit to go over whether there are any further screening items to consider. On the other hand, if cognitive testing showed severe cognitive deficiency, it might not be necessary to have more extensive testing, like imaging, for example.
Next, make sure you understand the type of dementia your loved one has been diagnosed with, and their prognosis. Some types of dementia are reversible, and oftentimes, proactive treatment can stave off decline.
2. Ask the medical team: What’s next?
Don’t leave the clinic or hang up the phone until you have your loved one’s next follow-up appointment set. Even if the cognitive decline was mild, ask: When do we need to come back in for repeat testing?
What’s next will depend on a few factors:
— Whether your loved one needs additional testing to clarify the diagnosis
— How severe the cognitive decline appears to be
— The age and physical abilities of your loved one
3. Ask about treatment plan details
Speak up, and ask for the details of your loved one’s treatment plan.
Also, enlist the help of nursing staff to answer questions or provide you with a written copy of the care plan. Nurses are not always able to answer questions about diagnosis, prognosis or medication dosing; however, nurses can answer a host of other helpful questions. The best questions to ask nurses about dementia are about lifestyle changes that come with a dementia diagnosis, how to care for your loved one and what to know about the care plan.
Make sure you understand the following details about your loved one’s treatment plan:
— Which specialists need to be involved
— Which medications the medical team recommends, such as cholinesterase inhibitors or memantine
— Nonmedical interventions to try, such as music, occupational or physical therapy. This may also include activities that stimulate memory and cognition, such as puzzles, scrapbooking or storytelling.
— Whether you can collaborate with a care coordinator or nurse navigator to help keep track of appointments, referrals and the care plan. Check with your insurance provider, treatment provider office and local community for available resources.
4. Arrange and get to know the care team
The care team is your lifeline after a dementia diagnosis.
The care team may include:
— You. As a loved one or caregiver, you are one of the most essential parts of the care team. You provide daily support to your loved one. Maybe you drive them to appointments, help them keep track of their schedule or even just offer a listening ear. All of this support cannot be understated.
— A specialist, such as a neurologist or geriatrician. A specialist is helpful in understanding the nuances of the specific type of dementia your loved one may have and recommending testing or treatments catered to those needs. You may not need a specialist right away.
— A primary care provider. Even if you have a specialist on board, a general practitioner is important to continue to manage overall health, help with care coordination and monitor your loved one’s progression.
— A mental health provider, such as a counselor, geriatric psychiatrist, social worker or licensed therapist. Mental health conditions can exacerbate or mirror cognitive decline. Additionally, a dementia diagnosis is a big change, and your loved one may need to talk to a professional about how they are feeling.
— Other support, such as neighbors, family members or friends, even if they live far away. In a pinch, you’ll want to have someone to count on when caregiving or supporting your loved one becomes challenging. Even if your support system lives far away, they can call and talk to your loved one, promoting cognition and memory recollection.
5. Begin care planning
Beyond dementia care, you’ll need a long-term, comprehensive plan for your loved one.
“Support is especially important early in the course of dementia when patients can still participate in the decision-making process,” Bryman says.
This includes:
— An elder law attorney. Dementia affects decision-making over time. Even if your loved one doesn’t need it now, get an advance directive, guardianship plan and power of attorney in place early. You’ll be grateful your loved one was able to participate in these decisions with as much cognitive ability as possible.
— A financial professional who specializes in seniors. Managing money can become risky with cognitive decline. A financial professional who understands asset and estate planning, and who can help manage investments, is helpful.
— Long-term care planning. As dementia progresses, individuals can lose the ability to physically care for themselves. Planning ahead allows you to decide on whether memory care or skilled nursing are options, as well as what to do for respite care. “Long-term care insurance is becoming increasingly common, so having that in place can be useful as well, given that if the patient requires increased assistance like living in a nursing home or assisted living, this can get quite costly,” Etienne says.
6. Use the new Medicare GUIDE Model, if eligible
The Medicare GUIDE, or Guiding an Improved Dementia Experience, Model is an eight-year initiative that provides monthly per diem support for team-based collaborative care for individuals with dementia. It offers structured support for care management and coordination, as well as caregiver education.
“One of the most meaningful aspects of the program is its inclusion of respite services for patients and their unpaid caregivers — an essential step in preventing caregiver burnout, which is common given the emotional and physical burden of caregiving,” Bryman says.
Does Medicare cover dementia screenings?
Medicare Part B helps cover a separate visit for cognitive testing for beneficiaries, as well as cognitive tests administered as part of your annual wellness visit. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
7. Employ healthy lifestyle habits
After a dementia screening, Etienne recommends:
— A healthy, Mediterranean-style diet
— Light exercise under the guidance of a provider
— Good quality sleep
— Social engagement
It’s also important to stick to other care plans you have for other conditions. For example, Etienne says an often overlooked factor is unaddressed hearing problems. Many who need hearing aids do not wear them, and this can worsen cognitive decline, Etienne says.
The Bottom Line
Even though it can be overwhelming to navigate what to do after a dementia screening, there are steps to take to ensure your loved one gets quality care.
“Facing a dementia diagnosis doesn’t have to mean surrender,” Aziz says.
Many individuals and families benefit from early planning, building strong support networks and taking advantage of resources, he adds.
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What to Do After Dementia Screening originally appeared on usnews.com
