Your risk assessment at the Precision Memory and Dementia Clinic may include some or all of the following:
- Thorough neurological evaluation
- Neuropsychological testing
- MRI scanning
- APO E gene testing (blood or saliva)
- Carotid artery ultrasound to test for narrowing and poor bloodflow to the brain
- Blood tests for CRP (C-reactive protein) and homocysteine levels
- Blood cholesterol and lipid testing
- Blood glucose and hemoglobin A1c (diabetes testing)
- Urinary F2 isoprostanes – the “gold standard” test for oxidative stress
- NutrEval test to measure fatty acid levels, specifically saturated, unsaturated and omega fats, in the bloodstream
- Vitamin and mineral testing to exclude deficiencies, including vitamin D and vitamin B12
How is a diagnosis of dementia made?
Dementia is a clinical diagnosis. This means that it is not diagnosed based on a laboratory or imaging test, but on the basis of a medical assessment which includes taking a detailed history from the symptomatic individual and/or other informants and performing an objective assessment of the individual’s cognitive abilities. Dementia is diagnosed if the clinical features fit predetermined diagnostic criteria. These diagnostic criteria have recently been revised and were published in 2013 in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). In order to be diagnosed with dementia (which they have now renamed ‘major neurocognitive disorder’), the individual has to have the following:
- Substantial cognitive decline from a previous level of performance in one or more cognitive domains as reported by the individual or an informant (in DSM 5, cognitive domains include complex attention, executive abilities, learning/memory, language, visuoconstruction/ visuoperception, and social cognition)
- There must be an objective decline in neurocognitive performance on formal testing
- The cognitive deficits are sufficient to interfere with independence (ie, requiring minimal assistance with instrumental activities of daily living such as paying bills or managing medications)
- The cognitive deficits do not occur exclusively in the context of a delirium
- The cognitive deficits are not primarily attributable to another mental disorder (eg, major depressive disorder, schizophrenia)
How is dementia treated?
Most causes of dementia cannot be cured. This includes the commonest cause of dementia which is Alzheimer’s disease. However, there are treatments available in Alzheimer’s disease to ameliorate the cognitive, functional, behavioural and psychological symptoms of the disease.
There are currently two classes of drug approved to treat the cognitive and functional symptoms of AD: the cholinesterase inhibitors donepezil, rivastigmine and galantamine, and the NMDA receptor antagonist, memantine. On the PBS, donepezil, rivastigmine and galantamine are licensed for mild to moderate AD, and memantine for moderate AD. Many other putative disease-modifying agents have been studied but failed to show a benefit, or are currently undergoing clinical trials.
Behavioural and psychological symptoms are common in Alzheimer’s disease, particularly in the later stages. These include anxiety, agitation, aggression, and psychosis (delusions and hallucinations), and are often treated with neuroleptic or antipsychotic medications.
Some medications that target arthritis have shown some promise in treating Alzheimer’s, however more work needs to be done to know if these approaches will provide a long-term benefit.
What is the prognosis for dementia?
Alzheimer’s disease is a progressive condition which causes a decline in cognitive functions over time. The average life expectancy for someone with AD is very variable, and ranges from 5 to 10 years or more. Individuals with AD have been known to live up to 20 years after the onset of symptoms.
What is cognitive neurology?
Cognitive neurology is that branch of neurology which focuses on brain diseases that cause impairments in mental functions. A practitioner in cognitive neurology will provide comprehensive assessment and treatment of difficulties relating to thinking, memory, language ability, attention and other cognitive functions. Dr Swee Tan [put link here] specialises in cognitive neurology.
What is a comprehensive memory and dementia clinic?
A comprehensive memory and dementia clinic is a multidisciplinary service which provides expert assessment, treatment, education and support for individuals with cognitive complaints and their carers. The specialist team usually comprises a cognitive neurologist, a neuropsychologist, an occupational therapist, a psycholoigist/family therapist and a registered nurse.
Precision Brain and Spine Centre will soon be opening its comprehensive Memory and Dementia Clinic. Please call our team on 1300 773 247 to register your interest.