Prescription medications often have side effects that cause a person to become disoriented in a way not dissimilar to those suffering from the early stages of dementia. This story illustrates how this can happen.
Linda’s husband, Dan, was not himself, and now that she thought about it, he hadn’t been for a while. He had trouble following conversations, was constantly misplacing things, and she discovered he had forgotten to pay the last two electric bills. This morning he had gone to the bank, just five minutes away, and was brought back an hour later by a neighbor who found him standing in the parking lot confused about how to get home.
Extremely concerned, Linda made an appointment for Dan with their doctor who ran a battery of blood tests and noted that Dan’s cholesterol and blood pressure medications seemed to be working. He referred them to a neurologist who administered the Mini-Mental State Examination (MMSE) to assess Dan’s memory. The MMSE assesses simple word, visual, and time/space orientation capabilities. The results showed that Dan had early-stage dementia. Dan received a prescription for Aricept, and Linda was given information on what to expect in the coming years.
Linda decided to get a second opinion with another neurologist who administered two different memory tests, the MIS and the AN. The MIS (Memory Impairment Screen)asks subjects to recall four words they saw several minutes earlier. For the AN (Animal Naming) test, as many animals as possible must be named in 60 seconds. In Dan’s case, The MIS showed no impairment, and the AN was borderline. Baffled by these three differing results, yet concerned by Linda’s observations, the doctor began looking elsewhere for a cause of Dan’s memory issues. He noted that some of Dan’s medications had dementia symptoms as a side effect, and recommended to Dan’s GP that the medications be re-evaluated, and changed or reduced if possible. He also referred Dan to a nutritionist and recommended that he start an exercise program, in the hopes of being able to reduce his medication. Dan and Linda left the office with new hope, and a plan for the future.
The three quick-tests for memory mentioned above are those most commonly used in a medical office setting. In a study published late last year, researchers from the University of Exeter, studying the effectiveness of these tests, found in a group of 824 subjects that 35.7% of cases were misclassified when just one of the tests was administered, 13.4% were misclassified by two tests, and only 1.7% were misclassified when all three were given. One of the report’s authors, Dr. David Llewellyn, said, “Our study found that all three tests often give incorrect results that may wrongly conclude that a person does or does not have dementia.”
“Each test has a different pattern of biases, so people are more likely to be misclassified by one test than another depending on factors such as their age, education and ethnicity.”
The conclusion was that administering all three tests led to fewer misdiagnoses, although rarely are all three given. As in the case of Linda and Dan, personal observation, asking questions and having an inquisitive doctor can lead to different conclusions and a different outlook for the future.
Individuals who take prescription medication(s) and who have been given just one quick mental test should not accept a diagnosis of dementia without another opinion and additional testing. And one quick test does not necessarily determine that an individual’s memory is operating at full capacity, especially if a friend or family member reports experience to the contrary. Patients and doctors must work together to make sure a proper diagnosis is given.
