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Bursack: Is cognitive testing worth the stress for older adults?

In today's "Minding Our Elders" column, Carol says there's a lot to consider.

Carol Bradley Bursack updated column sig for online 10-21-19.jpg
Carold Bradley Bursack, "Minding Our Elders" columnist.
The Forum

Dear Carol: My dad is 93 years old and having memory issues. He has several conditions that require a complicated system of medications so I manage those, but I’m wondering if he should be tested for dementia to find out what is going on. He suffers from anxiety because of having gone through so many medical procedures in his life.

Dad’s doctor says that based on his symptoms and other health issues, she wouldn’t recommend cognitive testing because it probably wouldn’t accomplish much other than to say that he has memory deficits. She also emphasized that Dad has health problems that are life-limiting, so she didn’t recommend putting him through any more than necessary. I agree with her in principle, but I’ve read the articles on testing and am feeling guilty for not doing everything possible for him. How important would testing be for him considering his age and health? — LD.

Dear LD: You sound like a devoted daughter and caregiver, so your concern is natural. With the current focus on testing, I’d probably be wondering the same thing if I were in your place. However, as you seem to understand, there are a number of things to consider, not the least of which is your dad’s age.

Remember that there’s an enormous difference between someone in their 60s who is experiencing memory loss and possible personality changes and someone in their 90s, especially if the only problem is some memory loss. Since there are well over 100 different types of dementia, including some that could be made worse by treatment meant to treat other types, younger people are nearly always better off if they are tested.

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A diagnosis could also make people eligible to join clinical trials that are testing potentially helpful drugs and therapies if they wish. Additionally, it provides them with more time to plan for their future care and to cement their choices about who will handle their health and finances when they can no longer do so.
The fact is most people his age will struggle somewhat with memory. Someone who is taking a complicated system of medications is nearly guaranteed to have issues since many drugs are anticholinergic (meaning they affect choline, which has to do with the brain). Since you’re already working with your dad’s doctor this likely has been considered, but it doesn’t hurt to ask.

If he were exceptionally healthy and in his early 90s I’d still be somewhat hesitant to put him through testing unless that was his choice, but perhaps there’d be a unique reason to do so. In your dad’s case, like the doctor, I have to wonder what would be gained.

If this were my dad, I’d ask him what he’d like to do, but I wouldn’t insist on testing unless he wants it. Work closely with his doctor, though, and ask for suggestions that can help increase your dad’s quality of life. Your biggest role now is to continue to love and assist him as he is.

Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.

Related Topics: WELLNESSNEWSMD
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