How is Dementia Diagnosed?

Diagnosing dementia involves a thorough evaluation by a healthcare professional to determine the cause of symptoms and assess the extent of cognitive decline. Since no single test can definitively diagnose dementia, a combination of assessments is typically used.

In Malaysia, early diagnosis is crucial to managing dementia effectively and improving the quality of life for patients and caregivers.

Diagnostic Methods for Dementia

Healthcare professionals use various tools and tests to diagnose dementia and its underlying causes. These include:

Medical History and Physical Exam

• A review of your medical history, symptoms, and family history.
• Input from someone close to you about observed symptoms.
• A physical exam to rule out other conditions.
  

Cognitive and Neuropsychological Tests

• Tests to evaluate memory, reasoning, judgment, language skills, and attention.
• These assessments help identify patterns of cognitive decline.

Neurological Evaluation

• Examination of movement, balance, reflexes, and sensory functions.
• Helps detect conditions like Parkinson’s disease or other neurological disorders.

Brain Imaging

• CT or MRI Scans: Detect strokes, tumours, bleeding, or fluid buildup (hydrocephalus).
• PET Scans: Identify patterns of brain activity and the presence of amyloid or tau proteins, which are hallmarks of Alzheimer’s disease.

Laboratory Tests

• Blood tests to check for vitamin deficiencies (e.g., B-12) or thyroid dysfunction, folic acid
• Spinal fluid analysis, if indicated, to detect infections, inflammation, or disease markers.

Psychiatric Evaluation

• Assessment by a mental health professional to rule out depression, anxiety, or other mental health conditions that may mimic dementia symptoms.

At SJMC, our team of neurologists, psychiatrists, and diagnostic specialists works together to ensure a comprehensive evaluation, enabling accurate diagnosis and tailored care plans.

Treatment Options for Dementia in Malaysia

While most types of dementia cannot be cured, treatments focus on managing symptoms, slowing disease progression, and improving quality of life. Below are the primary treatment options

Medication for Dementias:

Cholinesterase Inhibitors

• Boost levels of a chemical messenger involved in memory and judgment.
• Common medications: Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Zunveyl).
• Used for Alzheimer’s disease, vascular dementia, Parkinson’s disease dementia, and Lewy body dementia.
• Common Side effects: Nausea, vomiting, diarrhoea, slowed heart rate, and trouble sleeping.

Memantine (Namenda)

• Regulates glutamate activity, a chemical messenger involved in learning and memory.
• Common side effect: Dizziness.

New FDA-Approved Medications

• Lecanemab (Leqembi) and Donanemab (Kisunla): Approved for mild Alzheimer’s disease.
• These medications prevent amyloid plaques from clumping in the brain, slowing cognitive decline.
• Administered via IV infusion with potential side effects, including flu-like symptoms, nausea, and rare brain swelling or bleeding.
• Genetic testing for APOE e4 is recommended before starting treatment due to associated risks.

Other Medications

• Medicines to manage symptoms like depression, hallucinations, agitation, or Parkinsonism (slow and stiff movements).

At Subang Jaya Medical Centre (SJMC), we ensure that all medications are prescribed with a focus on patient safety and efficacy, tailoring treatments to individual needs

Therapies for Dementia

Occupational Therapy

• Helps make the home environment safer and teaches coping strategies.
• Aims to prevent accidents and manage behavioural changes.

Environmental Modifications

• Reduce clutter and noise to improve focus.
• Hide dangerous objects like knives or car keys.
• Use monitoring systems to ensure safety.

Simplified Tasks and Routines

• Break tasks into smaller, manageable steps.
• Establish a structure and routine to reduce confusion.

Lifestyle and Home Remedies

Caregivers and families can implement these strategies to improve the quality of life for individuals with dementia:

• Enhance Communication: Use simple sentences, maintain eye contact, and avoid rushing responses.
• Encourage Physical Activity: Exercise improves strength, balance, and cardiovascular health while reducing restlessness and depression.
• Engage in Enjoyable Activities: Activities like gardening, painting, singing or dancing can help individuals focus on what they can still do.
• Establish a Nighttime Routine: Calming routines and night-lights can reduce nighttime confusion.
• Use a Calendar: Helps with remembering daily activities and medication schedules.
• Plan for the Future: Develop a care plan while the individual can still participate in decision-making.

Alternative and Complementary Therapies

While some alternative therapies are popular, their effectiveness remains unproven. Use caution and consult a healthcare professional before trying these options:

• Music Therapy: Listening to soothing music.
• Pet Therapy: Interaction with animals to improve mood.
• Aromatherapy: Using fragrant oils for relaxation.
• Art Therapy: Creative activities to reduce agitation.
• Massage Therapy: Promotes relaxation and reduces stress.

Support for Caregivers and Families

Caring for someone with dementia can be physically and emotionally demanding. Here are some tips for caregivers:

• Learn about dementia and participate in caregiver education programs.
• Seek community support services like respite care
• Take care of your physical, emotional, and spiritual health.
• Join a support group to connect with others in similar situations.

Preparing for Your Appointment

If you suspect dementia, consult a healthcare professional. Here’s how to prepare for your visit:

What to Do Before the Appointment:

• Ask if any tests (e.g., fasting) are required beforehand.
• Make a list of symptoms, personal history, and medications.

Questions to Ask Your Doctor:

• What is the likely cause of my symptoms?
• What tests are necessary?
• How can dementia and other health issues be managed together?
• What treatment options are available?

What to Expect During the Appointment:

• Questions about symptom onset, severity, and triggers.
• A discussion about how symptoms affect daily life.

References

1. Mayo Clinic: Dementia – Diagnosis and Treatment
2. Alzheimer’s Association: Dementia Diagnosis
3. Alzheimer’s Association: Medical Tests for Dementia
4. World Health Organization (WHO): Dementia Diagnosis and Treatment
5. National Institute on Aging (NIA): What is Dementia?
6. National Institute on Aging (NIA): Steps After Dementia Diagnosis
7. Dementia Australia: Types of Dementia
8. Harvard Health Publishing: Dementia Overview