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A dementia usually develops gradually. The signs appear slowly and are mostly non-specific. Those affected misplace items, lack the right words in conversation, or repeatedly ask the same questions. Initially, this often goes unnoticed, both by those affected and their relatives. After all, everyone is occasionally unfocused, forgets things, or has a bad day.
Most of the time, communication also changes, leading to more frequent arguments or withdrawal. Those affected change in their behavior, appearing uninterested or aloof. They often don't even notice it themselves. Relatives have difficulty understanding the changes, making interactions more challenging for many. Such signs could indicate a dementia illness, which should be clarified. Although there are numerous online tests and questionnaires available on the internet, a reliable diagnosis can only be made by professionals.
Suspicion of Dementia: When to See a Doctor?
It often takes years for those affected to get examined and receive a diagnosis. Far too long, experts criticize. They recommend an early diagnosis. Because the earlier dementia is detected, the sooner treatment can begin. While medications and other therapies cannot cure dementia, they can alleviate associated symptoms and enhance quality of life. Moreover, an early diagnosis allows those affected and their families to better adapt to the changes and develop strategies for their new daily life. Additionally, those affected can autonomously decide how they wish to be cared for and supported.
When is the right time to see a doctor? When are symptoms noticeable? Experts advise: If memory problems have been occurring for at least six months and are affecting daily life, you should consult a doctor. There is really no "too early" time, because dementia can be detected even in its early stages.
First point of contact: General practitioner
If dementia is suspected, the first point of contact is always the general practitioner. They can conduct initial examinations and sometimes make a diagnosis, as well as prescribe specific medications for dementia.
If further investigations are necessary because the diagnosis is not clear, the general practitioner can refer to a specialist – a neurologist or psychiatrist. They are experts in diseases of the brain and can conduct thorough examinations. It is also possible to be referred to a memory clinic.
What is a memory clinic?
Memory clinics are facilities specialized in the diagnosis and treatment of memory disorders and other cognitive problems. They are often affiliated with universities and research centers. They are also called memory clinics or memory consultations. There are 200 such memory clinics across Germany. An overview of all memory consultations is provided by the German Society for Gerontopsychiatry and Psychotherapy e.V. (DGGPP). http://dggpp.de/gedaechtnissprechstunde/
At a memory clinic, a team of professionals usually consisting of neurologists, psychiatrists, psychologists, social educators, and nursing staff works together. Just as there is no single dementia disease, there is no single test for dementia. In the early stages, it can be tricky to make a diagnosis because the symptoms are mild and nonspecific. Making a diagnosis requires expertise and various examinations. General practitioners and specialists in their practice usually do not have the means and opportunities for comprehensive tests. Therefore, they refer the less clear-cut cases to a memory clinic. Specialists are also often the better contacts for those affected by rarer forms of dementia.
What happens in a memory clinic?
The process in a memory clinic often begins with a detailed conversation. During this, the symptoms and medical history are discussed with the doctor. It is important that patients bring letters from doctors, medication plans, and examination findings. Also important: bringing along aids like glasses and hearing aids, so that they can participate well in the neuropsychological tests.
The psychologists conduct various tests. The most well-known is the so-called clock test, but there are numerous other neuropsychological tests. These assess memory and concentration abilities, language comprehension, logical thinking, judgment, and visuospatial skills. These tests usually take place without family members, as patients should not be influenced.
The psychological tests provide initial indications of whether it is dementia, which form it is, and what the severity is. Some of these examinations are repeated regularly, usually every six months, to monitor the progress.
Further investigations: lab tests and imaging procedures
A physical examination also takes place. This includes blood and urine tests. These lab tests are used to rule out other conditions, such as metabolic disorders or a vitamin B12 deficiency.
If dementia is suspected, further examinations may be necessary, such as a lumbar puncture. A fine needle is used to extract cerebrospinal fluid from the spinal canal. Typically, changes in certain proteins can be detected in the cerebrospinal fluid in cases of Alzheimer's.
During diagnosis, imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) may also be used. These create images of the brain. This helps identify the affected region in the brain and determine how much nerve tissue is damaged. However, imaging techniques can also be used to rule out dementia and discover other diseases. For example, a brain tumor or bleeding in the brain could be behind the memory problems.
After the examinations, a treatment plan is created together with the patients. This may include drug therapy, cognitive training sessions, dietary and lifestyle changes, or psychological support. Family members are also involved.
Accompaniment after the diagnosis
The professionals in a memory clinic not only make the diagnosis, but also support and advise on the journey into the new daily life with the illness. Thus, a memory clinic team usually includes social educators or social workers. They can provide comprehensive information about long-term care insurance benefits, social assistance, and everyday life. Many affected individuals and their relatives fall into a void after the diagnosis, and the counseling serves as a valuable support for them. It initiates and assists with the first steps.
The experts also provide advice on support and relief services and can assist with the application for the care level. They are generally not responsible for long-term accompaniment. However, memory clinics can provide local help and self-help addresses and mediate helpful contacts and contacts.
Memory clinics are often affiliated with clinics and research centers, which sometimes also provides an opportunity to participate in clinical studies.
What can family members expect?
Relatives of people with memory problems often find important support in a memory clinic. They can receive information about the condition and learn how to provide good help. Sometimes there are also offers for self-help or to exchange experiences with other relatives.
To help caregivers adapt well to their new role, they need knowledge about dementia. It is also important that they take good care of themselves. Self-compassion and self-care are not just buzzwords but helpful measures to ensure the long-term well-being of caregivers. Only when they feel well can they provide good care for their relatives with dementia.
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From Peggy Elfmann
Sources:
https://www.stiftung-gesundheitswissen.de/wissen/demenz/diagnostik
https://www.alzheimer-forschung.de/alzheimer/diagnose/gedaechtnisambulanz/
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Peggy Elfmann: Dementia. Understanding and Mindful Support. Wort und Bild Verlag, 2022
