Wednesday, 30 May 2012

A diagnosis of dementia

The recent television episode Satyameva Jayate by popular movie star Aamir Khan on the dishonest practitioners in the medical profession reminded me how vulnerable we all are with our patients.
Most new caregivers newly starting their role of caregiving are also unfamiliar with the illness of their loved one. Very little is known about dementia in India.  Luckily the recent explosion in the use of social networks is bringing together those in need of information with those who possess and willingly share this knowledge. Check out this Facebook group. The Indian population in general looks upon the medical fraternity with awe and is very thankful for a few minutes of consultation time the specialists give them.    While this is not a bad thing, the caregivers have to educate themselves to understand the service they are getting is what they are seeking and paying for.   
Talking to most caregivers, I realise that doctors are not providing a complete check up before handing out a diagnosis of dementia.  As per the following would be required to arrive at a complete diagnosis.
1.       Patient history   -  to compare normal aging and dementia related symptoms the caregiver is the best person to provide this information
2.       Physical examination – to rule out other diseases/disorders that can overlap or medication that may be causing dementia like symptoms
3.       Neurological evaluations to look at balance,  reflexes, sensory functions
4.       Laboratory tests – blood tests, urine analysis, toxicology tests  etc to rule out treatable causes of the dementia symptoms
5.       Cognitive and neuropsychological tests – language skills, problem solving ability, other abilities required to perform tasks of daily living.  A Mini-Mental State Exam (MMSE) assesses cognitive skills in persons suspected with dementia. 
6.       Brain scans like CT and MRI can confirm the causes of the dementia symptoms and whether they are treatable.
7.       Psychiatric evaluation – to determine if the person is suffering from depression or other psychiatric disorder that also has dementia like symptoms
In my own experience, the neurologist we consulted had an overflowing waiting area and each person was allotted few minutes.  So we had to talk very fast battling the constant interruptions for the doctor’s attention.  The physical exam and neurological evaluation was cursory.  Cognitive and neuropsychological tests were not administered.  The doctor just asked us to get an MRI.  When the MRI was taken to him, he barely looked at all the plates.  Just wrote out Binswanger’s Disesase, Parkinson symptoms, Alzheimer’s disease and handed out a long list of medicines to be taken.   There was no explanation on diagnosis, treatment and prognosis.
Most others have similar experiences I believe.  I was recently told by one caregiver that their patient had been diagnosed with Lewy Body dementia by a psychiatrist based on verbal history of the patient’s behaviour and that too without even seeing the patient in person!  And the doctor has already prescribed medicines.   When I voiced my concerns, the caregiver also told me that he has asked for blood tests and MRI but they have yet to get these done and that the doctor is not just a psychiatrist but a neuro-psychiatrist!
Surely our medical fraternity can and should do better than this.   If we continue to accept lower standards of service, that is what we will continue to get.   Do we accept lower standards from our car mechanic, cable operator or mobile provider?  Then why do we silently accept lower standards in more important matters of health and perhaps even life and death?  


  1. Alzheimer's Disease is one form of dementia in the elderly that can be specifically diagnosed. On top of that other diseases, illnesses and disorders of aging and general health often are amiss.

    Alzheimer Clinic

  2. Dear Alzheimer Clinic, May I point you to the webpage of Alzheimer's Disease International ( I quote "A reasonably accurate diagnosis of dementia can be made by taking a careful history of the person's problem from a close relative or friend, together with an examination of the person's physical and mental status. There is, however, no simple test to make a diagnosis and dementia can only be confirmed with certainty by examining the brain after death." Therefore your comment that AD can be specifically diagnosed is incorrect.