For some reason, it seems like practitioners run away from diagnosing people with Alzheimer’s disease. I don’t understand that when, in fact, Alzheimer’s disease accounts for 75% to 80% of all dementias.
This is followed by vascular dementia at 20%, Lewy Body dementia (15%) and frontotemporal dementia (2%). Now, I am no mathematician but even I can see two things. One, that doesn’t add up to 100%. That’s because it is common to have vascular dementia overlapping other dementias.
Two, it is glaringly obvious that Alzheimer’s, not unspecified dementia, is the No. 1 dementia. As a matter of fact, there is no unspecified dementia category (except for ICD-10 coding). That just means you didn’t diagnose it.
Now I realize that Alzheimer’s disease cannot be fully diagnosed until performing an autopsy. And most people will not want an autopsy while still alive. Actually, if I can refuse an autopsy, please do not perform one on me! But come on, there are other ways to have a probable diagnosis and we are doing our residents/patients a disservice when we continue with these nebulous diagnoses we have in their medical records.
Let me count the ways: unspecified dementia with behavioral disturbance; unspecified dementia without behavioral disturbance; dementia in other diseases classified elsewhere with behavioral disturbance; dementia in other diseases classified elsewhere without behavioral disturbance; hallucinations unspecified or other psychotic disorder not due to a substance or known physiological condition or unspecified psychosis not due to a substance or known physiological condition (see this a lot with behavioral psychosis of Alzheimer’s disease along with that unspecified dementia); unspecified mental disorder due to known physiological condition; vascular dementia with behavioral disturbance; vascular dementia without behavioral disturbance…
And we often see multiple diagnoses because when they are admitted, we can have one and then we might get an updated diagnosis with another hospital readmission. But the old one stays on and maybe we get another from our practitioner. What a mess!
And we really do a disservice to those patients when we don’t have the Alzheimer’s diagnosis because without it, we limit both pharmacologic and nonpharmacologic treatments and appropriate care planning.
I’ve heard doctors are hesitant to give out the diagnosis for fear of the emotional reaction of the patient and or family. While, yeah, no one wants that diagnosis, neither does one want one of cancer, but doctors let their patients know when they have cancer. If you don’t diagnose it, you can’t appropriately treat it or deal with it and plan for the inevitable outcomes.
So come on, let’s run to diagnosing instead of running away. When we get these “unspecified dementias” or “dementia in other diseases classified elsewhere,” let’s force the docs’ hand.
Ask for a diagnosis or ask for a consult so we can get one. And for goodness sakes, let’s clean up our diagnosis sheets while we’re at it too. Just saying!
Just keeping it real,
Nurse Jackie
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
