Sunday, December 20, 2009

Dementia Misdiagnosis

Mary,a 92 year old woman who sustained a hip fracture, was admitted to a nursing home from a local hospital. The medical record was littered with the words dementia and alzheimers disease. I learned from staff that she was managing her affairs and caring for herself in an apartment prior to her fall. This was a red flag. The very first notation in the hospital record indicates severe dementia. But if she was so demented how could she have been taking care of herself so well. Was there a stroke or delerium that would have caused such a change?

On my initial interview I learned that she was not demented at all. She was hearing impaired. When I took the time, spoke to her clearly and gave her an opportunity to answer, I discovered she was cognitively more advanced than the staff. Once her hearing was corrected by a cerumen disimpation and a battery change in her hearing aids, we learned that she in fact she was a retired nurse and was well versed with health care.

There are lessons to be learned. First, don't rely on previous assessments. Mistakes like this tend to be repeated. Second, take a few moments to allow communication. Don't prejudge because of initial lack of response. And finally, all patients with a diagnosis with dementia should be tested for hearing loss. What you think is dementia may actually be in part or entirely due to a hearing problem.

1 comment:

  1. It is so true that unmitigated hearing loss can exacerbate symptoms of dementia/AD. Hearing should be assessed by an experienced audiologist prior to any formal diagnosis of dementia or AD. Physicians might find it helpful to keep a personal amplifier (i.e.Pocket Talker) on hand for use with patients with possible hearing loss. A patient may indeed present very differently when he/she is able to hear clearly what is being said.