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Published June 23, 2012, 11:30 PM

Bursack: Alzheimer’s diagnosis not always accurate

DEAR CAROL: My dad was diagnosed with Alzheimer’s disease three years ago. Recently, after the elimination of some medications Dad had been taking for years, the doctor changed the diagnosis to vascular dementia.

By: Carol Bradley Bursack, INFORUM

DEAR CAROL: My dad was diagnosed with Alzheimer’s disease three years ago. Recently, after the elimination of some medications Dad had been taking for years, the doctor changed the diagnosis to vascular dementia. In some ways, dementia is dementia, I guess, but still the doctor said as dad’s disease progresses the difference will become more apparent. I’m wondering how common this type of mix-up is with a dementia diagnosis. – Paul

DEAR PAUL: Actually, errors in dementia diagnosis are quite common. Peter Lichtenberg, Ph.D., head of Wayne State University’s Institute of Gerontology, wrote in a paper published in a recent edition of the journal Clinical Gerontology about this problem. In the article, he highlighted two case studies. In one instance, a man’s bouts of confusion and agitation during his late 70s were caused by illness and painful cellulitis, not Alzheimer’s. In the other instance, an 87-year-old woman who became very confused was suffering from depression. There were many other examples of flawed diagnoses in Lichtenberg’s study, as well.

Alzheimer’s can still only be definitively diagnosed after death. Doctors base their diagnosis on information from several types of tests including interviews about the patient’s work history and past interests, performance based tests that may include drawing assignments, memory tests using numbers and words, and technology based testing such as PET scans, which can now be enhanced by a newly FDA approved dye. All of the tools require a skilled diagnostician to interpret the results in order to get an accurate diagnosis.

Another problem in diagnosing dementia is that many people suffer from more than one type of dementia, called mixed dementia. In the end, this could be the problem with your dad. It’s possible that this last diagnosis is correct, but it’s also possible that your dad may eventually be found to have both Alzheimer’s and vascular dementia.

It’s important to get the most accurate diagnosis possible for a couple of reasons. One is that there are medications that can help slow symptoms in some people who have Alzheimer’s, but they work best if started fairly early. The other, of course, is that if a person has something like a urinary tract infection, which is quite common in elderly people, he or she can present dementia-like symptoms. The infection needs to be cleared up quickly to keep it from become a kidney problem or worse. If a careful diagnosis isn’t made and something like a UTI is left to fester, not only is the person treated for the wrong illness, he or she may also have another health issue that isn’t being addressed.

It’s generally advisable to get a second opinion from a specialist, especially if the doctor who first diagnosed dementia is not a neurologist or other specialist in brain disease. By getting a second opinion, you can be fairly sure that the diagnosis is correct.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com.

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