Dementia: It’s Time to Talk
Dementia: It’s Time to Talk

Families and community providers alike ask us what’s the point of pursuing a referral to a cognitive disorders neurologist when there’s no cure for dementia. On the surface, that’s a reasonable question.

Here’s how neuropsychiatrist Dylan Wint, MD, Director, Cleveland Clinic Lou Ruvo Center for Brain Health, responds: “There’s no cure for diabetes; yet, it would be ridiculous for a patient or their doctor to skip checking blood sugar because ‘we can’t fix it.’”

Research indicates that “not talking about it” is the approach many providers take with dementia — even though, like diabetes, symptoms of Alzheimer’s disease (AD) and related dementias can be managed. The goal of treating chronic, incurable conditions is to forestall or prevent complications. For diabetes, those risks include heart and kidney disease, nerve problems and strokes. For degenerative brain diseases, complications can include car accidents, nursing home placement and medication errors.

Forty-nine percent of elderly patients with suspected dementia are not told about it. This concealment is disturbing notes Dr. Wint, because research from the Harvard School of Public Health (2011) and others supports patients’ desire to know their condition. In fact, 75-80% say they’d want to know if their doctor had information suggesting they had a dementing disorder.

Provider discomfort is real

While research shows that providers have no difficulty discussing cancer and other potentially fatal diagnoses, stigma remains around AD.

There are solid medical reasons to discuss and investigate: medications can slow the loss of function and delay nursing home placement up to two years. Rehabilitative interventions can preserve independence.

“Given that symptoms of varied dementias start to converge later in the disease process, earlier diagnosis enables us to offer more precisely targeted interventions and support to individuals and their care partners,” explains Dr. Wint.

Threats of inaction are real

Those who know they have dementia are more likely to take appropriate safety precautions, while individuals who are unaware may inadvertently harm themselves or others through unassisted caregiving (perhaps for a grandchild), preparing hot meals alone, driving, or mismanaging personal finances.

During an August event, Dr. Wint shared with community providers research measuring patient mood before and after a diagnosis: “We actually relieve depression and anxiety by delivering a diagnosis, helping patients and families move on to living well with dementia.”

Looking ahead: the future of dementia care

The progression of neuroscience makes it even more likely providers can deliver accurate diagnoses.

“Images generated today by MRI have given us clear evidence of changes in the brain to share with patients, and blood tests are on the horizon to provide low-cost, minimally invasive confirmation of disease right in our lab,” says Dr. Wint. “As more disease-modifying therapies become available, we will be empowered to change the trajectory of disease once we’ve identified its presence, which heightens the importance of preventing complications now.”

Wondering if you or someone you know can benefit from learning more about brain changes? Make an appointment with the Cleveland Clinic neurology team: 702.483.6000.

For more information, review “Benefits of Knowing” and “Why are We Failing to Diagnose?”

Photo: Dylan Wint, MD, Director of Cleveland Clinic Lou Ruvo Center for Brain Health. Courtesy of Cleveland Clinic.

Back to All