Can a doctor diagnose someone with dementia just by looking at them?

February 8, 2013 1:21 PM

My dad went to a doctor; the doctor told him, out of nowhere, he had early-onset dementia. What gives?

My mother went to her doctor for her annual checkup. My dad accompanied her. When he saw that the waiting room was empty, he scheduled an impromptu appointment for his busted shoulder. I don't know if this is relevant, but this woman is not my father's doctor and had never seen him before this appointment. Also, if this helps, my mom claims she's never talked about my father to her doctor, either.

The doctor recommended physiotherapy for my dad's shoulder. He also found out he had high blood pressure. So far, so normal.

She then, apropos of nothing, asked my father if he'd had memory issues. My father has always had issues with short-term memory since I can remember (since he was, say, in his mid-thirties). So my father told her that, but nothing that had gotten worse. She asked my father if his job performance was affected by his memory loss. (?)

She then told him that he had early-onset dementia. It was beginning, she said, and it would get progressively worse as time went on.

This seems kind of strange. She doesn't know my father's medical history. None of us (my mother, myself or my brother) have noticed any deterioration in my father's memory or in any other cognitive function. When my father asked her how she could know, she said that she just knew. (Then, when he asked her if it was her "physician's intuition", and she repeated that no, she just knew.) She also kept calling my dad "Sri" when his name is "Sid", though he corrected her repeated times. I'm not sure if that's relevant, but it happened, so I'm including it.

Admittedly I am not a doctor and neither is the internet. But I did read that a diagnosis of dementia usually takes six months of rigorous multi-disciplinal testing. And, though I do have a family history of dementia, most of those people experienced dementia in their eighties and nineties. I'm not saying that the diagnosis is impossible -- though it is really fucking scary -- but can a doctor really make these conclusions on such little information?

posted by orangutan to health & fitness (16 answers total)

Oh, I should also mention that I work pretty closely with my father professionally, and have noticed absolutely no change in his job performance; he's as sharp as he's ever been.
posted by orangutan at 1:24 PM on February 8 [1 favorite]

This seems off to me. My dad has late-stage dementia, but my mom noticed that something was off long before her doctor or even us kids noticed. We spent several years responding to her query: "Do you notice a difference in him?" before we ever saw it ourselves.

This is definitely worth seeing a specialist for! I wouldn't take this doctor's diagnosis as a fact just yet...
posted by summerstorm at 1:25 PM on February 8 [5 favorites]

The short answer to the question is that no, that is not typical.

Could she have done a Mini Mental Status Exam during the appointment? There are still typically other diagnostics that are done prior to making any diagnosis of dementia, to rule out other issues.

If I were him I'd be getting a second opinion right away.
posted by treehorn+bunny at 1:25 PM on February 8 [2 favorites]

Also, keep in mind that what you're hearing about this appointment could be affected by hearing it secondhand. Not because your dad is confused, but because people typically do have difficulty remembering exactly what doctors tell them, especially when they're receiving emotionally fraught or difficult news. If you can go along to the next appointment (with a different physician) as an advocate, it would probably be helpful.
posted by treehorn+bunny at 1:28 PM on February 8 [12 favorites]

I wasn't at the appointment, and you weren't either, but it doesn't sound from what you've said that this doctor made a diagnosis "just by looking" at your father. She talked with him and checked his vitals. Skilled physicians can get a surprising amount of information from this sort of examination.

That being said, this doesn't sound like the kind of rigor that would normally go into such a diagnosis. So I wouldn't necessarily conclude that it's correct. But I would schedule a followup appointment--with a different physician--to check this out more thoroughly. This doctor noticed something that seemed "off" to her. That's probably worth looking into.
posted by valkyryn at 1:39 PM on February 8

I'd encourage your dad to see a neurologist and have cognitive screening done. The whole diagnosis sounds as if it was reached pretty quickly. IANAD, so please take my advice with the usual grain of salt.
posted by wolfgirl at 1:43 PM on February 8 [1 favorite]

I'd be skeptical, but I'd be out looking for a neurological work-up just to be safe.

I'd also look into this doctor, sounds like there's a reason her waiting room is empty.
posted by Ruthless Bunny at 1:48 PM on February 8

Get a second opinion, natch. Also, did the doctor recommend a course of therapy? Some expensive drugs, perhaps? When trying out new doctors I have had them try to diagnose me with conditions of which I did not complain (acid reflux in once instance) and try so aggressively to put me on a course of drugs I was forced to conclude they were somehow sales-incentivized. Bear that in mind.
posted by BigLankyBastard at 2:04 PM on February 8 [2 favorites]

Yes this does seem strange. First she seems to have very little information to go on, even if she did do a MMSE. Second the way it was told appears to be, to put it mildly, a little bit odd. For reference, when my parent was diagnosed, first they did a MMSE, which was passed, later they did a thorough consultation which included relatives. Then there was a referral to a specialized clinic where there was a whole Day of testing including amongst other diagnostic stuff, talks with family, cognitive testing and scans. And only then did the neurologist explain to the patient together with family what the diagnosis was, while showing them all the results including the scans. All that time nobody mentioned any diagnosis, they were very careful and respectful as they should be, because it's a very, very serious and painful diagnosis.
After, there was another talk about the future. So yeah.....
(It was actually a little too much even for us as relatives, but afterwards it helped tremendously to be so certain.)
posted by oenzemain at 2:05 PM on February 8

Just tangentially, the issue about "Sid" versus "Sri" may just be cultural. Sri is a polite form of address in Sanskrit languages, or so my crossword puzzle experiences tell me.
posted by uncaken at 2:15 PM on February 8

I'd say your dad should get a second opinion from his usual doctor. One thing that sticks out to me is that, AFAIK, there are various specific tests for dementia, and from what you've said it doesn't sound like this doctor administered any of those tests. Also, dementia as a diagnosis (in my understanding) involves ongoing monitoring.

That said, my grandparents are both experiencing dementia (they are in their 70s), and one HUGE ongoing problem is that they are no longer reliable narrators. Especially about medical issues, reporting what happened at doctor visits, etc. My mother has to go to all doctor visits with them, because otherwise she would never know the truth about what's happening with their health. They cannot be trusted to go to the doctor, understand what the appointment is about, and actually do what the doctor tells them to do (whether that's "come back in a month" or "take this medication" or what). She started going with them when they started coming home from doctor appointments with crazy stories like this.

Your dad's attempt to explain what happened at the doctor could be a red flag that maybe there's something to this diagnosis, if you've noticed other strange memory oriented things that weren't there before. Without any other red flags but with the knowledge that he has short term memory loss, I'd say that the whole thing is maybe a pale yellow flag. Something to take note of and maybe follow up with his regular doctor, but not something to completely freak over.
posted by Sara C. at 2:38 PM on February 8 [2 favorites]

Based on your father's description, the whole thing does sound a little suspect. That said, my mother was diagnosed with moderate dementia about a year ago. And it felt like she went from "getting a little forgetful" to "how do we get her the care she needs" overnight because we wrote off her obvious memory lapses as typical for someone her age and missed LOTS of less-obvious ones.

In other words, seeing someone all the time can make you less likely to notice changes in their behavior. My mother's doctor doesn't allow me in the room while conducting her memory tests so I can't unconsciously influence her responses, and hearing what happens from the next room can be a real eye-opener.

I'm not saying your dad has dementia, and I really hope he doesn't. But I would definitely agree that he should follow up on this with another doctor, and have someone go to the appointment with him.
posted by camyram at 4:17 PM on February 8

Hello, everyone, and thanks for your responses. They've been very helpful, especially since I've been freaking out.

I wanted to add -- and I realize after reading my question that this is a serious omission -- I heard about the whole appointment from my mother, who was present for about 70 percent of the conversation.

I will definitely ask my dad to see another doctor and get a second opinion. Thanks again, all.
posted by orangutan at 5:12 PM on February 8

When my grandmother was diagnosed, there were all kinds of little tests they did like having her draw a clock and some other little diagrams. In addition, there was a long interview and other kinds of testing. We went to a doctor that specializes in dementia at USC.
posted by dottiechang at 6:19 PM on February 8

For starters, I'd strongly lean toward giving the doctor the benefit of the doubt and good intentions, and assume that she suggested to your father that he may have early-onset dementia, but even assuming anything she might have done to reach this conclusion the normal course would be for a referral to a specialist.

My dad has dementia (we just brought him back home from the nursing home, as he is exhausting his long-term care insurance) of a type (frontotemporal) that does manifest somewhat earlier than the typical Alzheimer's case. His diagnosis consisted of a neurological examination including and MRI and a consultation with a neuropsychologist, who administered a series of cognitive tests that took several hours. There wasn't any six months about it other than appointment waits, but by that time it was getting fairly obvious even to casual observers that something was really off. As summerstorm intimated, usually the close relatives and friends of a dementia patient can tell that something is changing well in advance, and for us we would often think of things that came years before and consider, "Could that have been a sign?" For instance, there was a traffic accident where he was written up as blowing a stop sign, but he insisted he had been on the street that did NOT have the stop sign. We figured it was strange, because there wasn't any reason for him to have been going that way -- and only later realized that maybe the truth was that he'd had a lapse and was not only confused about the geography while driving but also while arguing to us. We tend to take people -- especially our parents -- at their word.

For yourself, the confidence you feel that your dad is pretty much hale is the best available diagnosis here, and it's one where a layman's view is somewhat justified. I would rest easy, but I would also take this doctor's questions seriously and have his regular physician weigh in, and consider a neurological checkup.
posted by dhartung at 9:15 PM on February 8

Wow,
I'd say that clearly, that doctor has got a problem. Even if she had a reason (which one ?) to suspect that your father had some issues, the way she established her diagnosis is shallow, and the way she delivered it was careless and unethical. RED flag.
posted by nicolin at 8:41 AM on February 9