Losing my father: Comprehensive geriatric assessment identifies nature of dimentia

Dementia means "deprived of mind." It is not a disease itself, but a range of symptoms that characterize several diseases and conditions, all of which are identified by declining intellectual functioning that goes beyond normal aging. The decline is severe enough to interfere with the ability to perform routine day-to-day activities.

Alzheimer’s disease is just one condition that falls under the umbrella term of dementia. Although Alzheimer’s progresses differently in different people, memory is always affected. The question for many families is how to tell if memory loss is caused by Alzheimer’s or by another condition, one that may be reversible.

Dr. Mathew Wayne, the medical director of University Hospitals Foley Elder Health Center explains the importance of getting a comprehensive geriatric assessment whenever there are concerns about memory loss, confusion, or other signs of dementia.

"The comprehensive geriatric assessment is a diagnostic tool. It evaluates everything that is going on in a person’s life—medical, functional and psychosocial, the pattern of symptoms, and which areas of the brain are affected," explains Dr. Wayne.

There can be many causes of memory and thinking problems, including vitamin deficiency, lack of sleep, thyroid imbalance, depression or medication interactions. Therefore, a thorough geriatric assessment is one of the best ways to determine the actual problem and its cause.

"What often looks like Alzheimer's or dementia can sometimes be the result of other medical or psychiatric problems," Dr Wayne points out.

A team consisting of a physician, nurse and social worker and, if indicated, a psychologist and occupational or physical therapist performs the comprehensive geriatric assessment. The assessment includes reviewing the extent of the memory loss and a functional review to evaluate its effect on daily activities, lab work, CT scans and other diagnostics.

One frequently used assessment tool is the clock test, which evaluates visual, spatial and executive functioning (i.e. whether numbers on the clock are arranged correctly). When asked to draw a clock showing the time 3:45, my father took the pencil and made some marks on the paper and then angrily pushed away the paper, shouting, "I don’t know how!"

The goal of the assessment team is to develop a comprehensive care plan, which is presented to the person and family at the summary conference. Dr. Wayne stresses the importance of involving family members in order to educate them about the problems identified in the assessment. The team outlines the care plan--the interventions and supports that are needed for the patient--and determines which of these are already in place. Finally, the team makes specific recommendations regarding additional community resources.

"The Foley Elder Health Center is built to be a comanagement program," says Dr. Wayne. "We work with the primary care doctor and stay involved according to the patient’s needs and wishes, and modify the care plan as needed." The Foley Elder Health Center can be reached by calling 216-464-6445.

Lita Gonzales, a longtime community volunteer, lives in Cleveland Heights with her husband Mark. Her father suffers from Alzheimer's disease.

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Volume 2, Issue 12, Posted 5:23 PM, 11.16.2009