Though it is true that Alzheimer’s disease can only be truly diagnosed at autopsy, medical research has come a long way and has identified different methods of testing to determine the probable cause of dementia symptoms. Though sometimes the probable cause of dementia can be diagnosed right at the doctor’s office, often times, more testing and information is needed to make an accurate diagnosis.
In order for someone’s condition to be considered a type of dementia, it must affect at least two of the five of the following thinking areas: memory, reasoning, visual-spatial abilities, language, and personality/behavior. The change in these thinking areas has to be severe enough to affect everyday life and must be a decline from the person’s baseline function and abilities.
Assessments to determine memory or cognitive concern usually begin with a full physical exam. As we know, there are many things that can cause dementia-like symptoms (i.e. medication interaction, infection, vitamin deficiency, etc.). The physician looks at motor skills, gait, blood test results, and more to get a good idea of the patient’s current level of physical health and function. The physical exam can also sometimes include a neurological exam involving a brain scan. These scans can sometimes help the physician see physical changes occurring in the brain, though are not always necessary based on other symptoms and findings. An in-depth assessment can also rule out various potential medical causes, including a temporary, but severe state of confusion called “delirium.”
The physician also completes a variety of cognitive testing on the person in question. These tests are examining memory, language, problem solving, and more areas of the brain to get an accurate picture of the person’s current cognitive abilities and challenges.
Physicians will also take into account the feedback from both the patient with memory concerns and input from close family and friends. This input can provide the doctor with an idea of what behavioral symptoms or changes they have noticed as well as a timeline that these symptoms may have begun or increased in severity.
The physician takes into account a combination of all of these symptoms, test results, and interviews with both the patient and family members. Based on the evidence gathered by the physician, they make their best judgment to determine the cause of these symptoms and make a diagnosis and recommendations if necessary. If you are concerned about a loved one or yourself, talk to your primary care physician for a referral.
Sources: Dr. David Reuben, Chief, Division of Geriatrics at the David Geffen School of Medicine at UCLA. Director, UCLA Alzheimer’s and Dementia Care Program. “Overview of Diagnosis, Treatment, and Management.” Presentation given on 7/30/2019. | wai.wisc.edu/clinics/overview
