Question: My mother and father are in their early 80’s. Both are both hard of hearing, and both refuse to wear hearing aids. It seemed to the family – including Dad – that Mom’s memory was slipping intermittently. So, to make sure we stayed on top of things, we took her to her long-time family doctor.

After talking to her, Dad, and me for about ten minutes, but without giving her any testing, he concluded she had at least a mild dementia and prescribed a medication for her that he said might work. But it has done absolutely no good over the past six weeks. She has had indigestion, headaches, and generally feels bad. Upon calling her physician, he took her off the medicine and told us to let the condition run its natural course.

We are concerned that something is missing here. Her doctor noted in her chart that she suffered from dementia. We live in a small town, and have very few health care choices, and therefore, don’t want to tick off her doctor. Do you have any suggestions?

Answer: Based on the description you give, it appears that your mother’s doctor jumped to the diagnosis of “dementia” prematurely, especially when conducting no tests.
Generally, if a patient is confused or disoriented, a test called the Mini Mental Status Examination (MMSE) is given to try to ascertain the patient’s level of cognition. Apparently, however, your mother’s physician apparently did not conduct this test.

For this and other reasons, we believe that dementia is often over-diagnosed and misdiagnosed, while at the same time, other reasons for memory loss are ignored. For example, normal aging carries with it some symptoms of mild memory loss, as do depression, delirium, emotional problems, and a number of physical conditions, including brain tumors and strokes.

For example, if an individual suffers multiple strokes in the brain – called “ministrokes” - insufficient blood supply destroys brain tissue. This, in turn, causes a reduction in cognitive function that may create symptoms similar to dementia or Alzheimer’s disease.

Based on studies and statistics we have researched, the two medical problems in our geriatric population that present major difficulties in diagnosis are depression and dementia. When you consider that those over age 85 are the fastest growing segment of our population, this is a growing problem for both older people and their physicians.

Why are a high percentage of geriatric patients who suffer from depression misdiagnosed as suffering from dementia? Because of lack of proper assessment of their cognitive functioning, and misperceptions about normal aging.

But there is yet another issue that may lead to a misdiagnosis of dementia: Hearing loss.

Those with hearing loss -- such as your mother -- may well become anxious in medical situations, become confused and disoriented, and not be able to understand what is going on. For more information about hearing and dementia, contact Northern Virginia Resource Center for Deaf and Hard of Hearing Persons (NVRC), 3951 Pender Drive, Suite 130, Fairfax, VA 22030; www.nvrc.org. 703-352-9055 V, 703-352-9056 TTY, 703-352-9058 Fax.

For more information about misdiagnosis, and to see the Mini Mental Status Exam, go to our home page and click on “Diagnostic Momentum”.