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older couple speaking to a female doctor during a cognitive assessment

Preparing for a Cognitive Assessment and Talking with Your Doctors

Seeing the early signs of dementia in someone you love is emotionally overwhelming. You may feel like you’ve come to a turning point in life: everything’s going to be different from now on.

How should you respond? Should you plan ahead or should you take it one day at a time? The answer is: Both. “One day at a time” is wonderful advice for handling the emotional side of any new journey. We shouldn’t let anxieties about the future overwhelm the present moment. But for the logistical side of helping someone you love navigate dementia, planning ahead is extremely important. Having an idea about what to expect helps you prepare better. This is especially true when you plan for your first appointment for a cognitive assessment.

I wrote earlier with some tips about what to expect from your first cognitive health visit. If you know what kinds of questions the doctor will ask, you’ll have a chance to think about them beforehand, and you’ll be prepared to illustrate your general answers with specific examples. For example, “Mom doesn’t cook like she used to” could just mean she’s lost the energy to do the Thanksgiving marathon she was famous for—or it could mean she’s having difficulty keeping track of the steps of a recipe. These are very different! So plan to follow up each general observation with a “For example…”

Having a clear sense of what to expect, so you can efficiently plan ahead, can be immensely helpful in allaying anxieties and helping you feel ready and able to take on the future.

Another thing to keep in mind when you’re thinking ahead to your first cognitive health visit: When we think of Alzheimer’s disease, we think of cognitive problems. But dementia also causes general mental health troubles, such as apathy or depression. The doctor will screen for emotional changes, which are a big part of the picture. Expect questions about motivation,  expressions of affection, participation in conversations, anxiety, irritability and argumentativeness, and impulsivity. Any impairment in judgment you have noticed is important to bring up—again, with specific examples to illustrate your statement.

Your first stop, ideally, will be with your loved one’s primary care doctor, who knows their history and who can refer you to a geriatrician, neurologist, or psychiatrist if necessary. The PCP can also do a complete physical exam to look for signs of conditions such as cardiovascular diseases, silent stroke, and different kinds of Parkinson’s disease. There are many conditions that can contribute to or cause dementia.

The doctor may arrange for some testing. Laboratory tests will probably be tailored to the patient’s medical history. Blood tests can rule out liver and kidney problems, thyroid problems, vitamin deficiencies, blood sugar problems, bacterial and viral infections, and exposure to toxic substances. These are treatable conditions that can contribute to dementia, so it’s important to test for them if the patient’s history warrants.

There are also imaging tests that may be appropriate, such as a CT-scan or an MRI. These are especially important if your doctor thinks there’s something atypical about the symptoms you describe. Your doctor can also refer your loved one for neuropsychological assessment, specialized genetic assessment, and lab tests for biomarkers.

Maintaining a balance between finding peace and joy in the present moment and planning ahead for a daunting array of appointments, tests, and ever-changing arrangements—well, that’s an accomplishment you shouldn’t expect to achieve immediately. That’s a journey too. Even here, though, having a clear sense of what to expect, so you can efficiently plan ahead, can be immensely helpful in allaying anxieties and helping you feel ready and able to take on the future.