I was nervous the first time I went with my mother to the memory disorder clinic… I guess it comes with the territory, but I thought it might be useful to outline some of the process.
Before you go you should ask to have any relevent lab and test results forwarded to the doctor who will be doing your loved one’s cognitive assessment. They will probably require additional tests, but they can at least look at what has been done so far.
On the day of the appointment, showing up, of course is the most important thing, but there are a few things you might want to think about before you go. You should bring a list of all the medications your loved one is currently taking, as well as their complete medical history. Since I was living with my mom, the med list was pretty easy, but the medical history was a bit harder. Enlist your loved one’s physician, your siblings, etc.
Get to the appointment early. Not only does it give you time to fill in paperwork, it also gives the patient a moment or two to adjust to someplace new.
The bulk of time during the doctor’s, outside of waiting around and filling in paperwork, will be taken up with a cognitive assessment. Don’t worry it’s painless… or at least physically painless. It consists of a series of questions or tasks.
The hardest part of the exam is sitting on your own hands and biting your own tongue. Many Alzheimer’s sufferers develop their own coping mechanisms to compensate for their diminished capacity. It’s equally true that caregivers also develop compensating skills. We finished sentences, take over tasks and provide hints. Keep in mind, the examiner is not interested in whether you know what season it is or whether you can read and follow simple instructions or copy geometric figures.
As I got more used to going to these evaluations, I made a practice of asking the doctor to tell me specifically when he wanted me to answer something, even outside of the actual cognitive assessment portion of the visit. It took a few visits, but I finally realized that he needs to see the whole picture of what my mother can and cannot do…even if it slows down the visit. So while you are there, sit down and shut up. So what if it takes forever. That is what you are there for.
The cognitive assessment only determines cognitive skill levels; it’s an indicator of whether your loved one is suffering from some sort of diminished capacity. It cannot establish the cause of that diminishment. Unfortunately, there is no test yet that definitively determines whether the cause is Alzheimer’s. What’s left, then, is to determine that it isn’t anything else.
In addition to the cognitive assessment, the doctor should do a couple additional tests to conclude a patient is suffering from Alzheimer’s. A physical exams should be done as a matter of routine, looking at blood pressure, temperature, vision, pulse, etc. A neuro exam, often combined with the cognitive assessment, should look at coordination, reflexes, balance, and gait.
The doctor should rule out drug interaction or drug allergies, hence the need for a complete medication list. He should review medical history for other injuries, like a head injury, for example; or for conditions like heart disease that may affect blood flow to the brain.
Blood work needs to be done to rule out a number of other possible sources of memory loss, like hypothyroidism, diabetes, or infection.
The most debated test, I think, is imagery. It may not be the standard of care if there are no other symptoms that indicate stroke, hydrocephalus, or tumors. If you have any doubts, though, I would insist on having an MRI, CT or PET scan.
Because blood work will probably still be pending, you won’t leave the doctor’s office with a firm diagnosis.
Because of the nature of the disease, you won’t ever have a firm diagnosis, but there are treatments that have been shown to be moderately effective in lessening some of the symptoms.
So go.
