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Steps to Getting
a Diagnosis: Finding Out If It's Alzheimer's Disease
The diagnostic process involves the following:
1. Determination of Medical History
The person being tested and family members will be interviewed both
individually and together to gather information on the person's
daily functioning, current mental and physical conditions, and family
medical history.
2. Mental Status Evaluation
During the mental status evaluation, the person's sense of time
and place, and ability to remember, understand, talk and do simple
calculations will be assessed. The person may be asked questions
such as: "What year is it?" "What day of the week
is it?" "Who is the current president?" The person
will also be asked to complete mental exercises, such as spelling
a word backwards, writing a sentence, or copying a design.
When reviewing the test results, the physician will consider the
individual's overall performance in relation to his or her educational
background and occupation.
3. Physical Examination
During the physical examination, the physician will evaluate the
person's nutritional status and check blood pressure and pulse.
The physician will also search for the presence of cardiac, respiratory,
liver, kidney and thyroid diseases, and atherosclerosis (hardening
of the arteries). Some of these conditions can cause dementia-like
symptoms.
4. Neurological Exam
A physician, usually a neurologist, will closely evaluate the person's
nervous system for problems that may signal brain disorders other
than Alzheimer's disease. The physician will search for evidence
of previous strokes, Parkinson's disease, hydocephalus (fluid accumulation
on the brain), a brain tumor, an other illnesses that impair memory
and/or thinking. The physician will learn about the health of the
brain by testing coordination, muscle tone and strength, eye movement,
speech and sensation. For example, the physician will test reflexes
by tapping the knee, check the person's ability to sense feeling
on their hands and feet, and listen for slurred speech.
5. Laboratory Tests
A variety of test will be ordered by the physician to help diagnose
Alzheimer's disease by ruling out other disorders. A complete blood
count and blood chemistry will be ordered to detect anemia, infection,
diabetes, and kidney and liver disorders. Levels of vitamin B 12
and folic acid (a vitamin produced by the body) are measured, as
low levels can be associated with dementia. Since very high or low
amounts of the thyroid hormone can cause confusion or dementia,
levels of the thyroid hormone are measured through a blood test.
This test can detect conditions such as epilepsy, which can sometimes
cause prolonged mild seizures that leave a person in a confused
state.
A CT (compuerized tomogrophy) scan, which takes X-ray
images of the brain, is also frequently used. The brain is scanned
for evidence of tumors, strokes, blood clots and hydrocephalus.
MRI (magnetic resonance imaging) is another brain-imaging technique
sometimes used. More experimental tests may also be recommended
but are not necessary for the diagnosis. These include PET (positron
emission tomography), which shows how different areas of the brain
respond when the person is asked to perform different activities,
such as reading, listening to music, or talking; and SPECT (single
proton emission computed tomography), which shows how blood is circulating
to the brain.
6. Psychiatric, Psychological and Other Evaluations
A psychiatric evaluation can rule out the presence of other illnesses,
such as depression, which can result in memory loss similar to dementia
of the Alzheimer type. Neuropsychological testing may also be done
to test memory, reasoning, writing, vision-motor coordination and
ability to express ideas. These tests may take several hours, and
may involve interviews with a psychologist, as well as written tests.
These tests provide more in-depth information than the mental status
evaluation.
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Understanding the Diagnosis
Once testing is completed, the diagnosing physician
or other members of the diagnostic team will review the results
of the examinations, laboratory tests and other consultations to
arrive at a diagnosis. If all test results appear to be consistent
with Alzheimer's disease, the clinical diagnosis will be "probable
Alzheimer's disease," or "dementia of the Alzheimer type."
If the symptoms are not typical, but no other cause is found, the
diagnosis will be "possible Alzheimer's disease."
Although researchers have made enormous progress in
diagnostic testing, the only way to prove Alzheimer's disease is
through autopsy.
If a cause of dementia other than Alzheimer's disease
is diagnosed, call the Alzheimer's Association to request a free
informational brochure about related causes of dementia. The Family's
Role in Diagnosis While some people with Alzheimer's disease may
initiate their own diagnosis and care, for most, it will be up to
another family member to alert the physician.
Here are some tips that will help you get someone
to the physician for an initial evaluation:
- Schedule an appointment for the person.
- Help with transportation to the appointment.
- Read this booklet as a family to gain a better understanding
of what to expect during the diagnostic process.
- Contact your local chapter of the Alzheimer's Association if
you have any concerns or questions.
- Offer to accompany the person during the testing process if
he or she is still uneasy about investigating possible Alzheimer's
disease.
On the day of the appointment, bring along items such
as glasses, hearing aids, devices that help the person walk, a list
of medications the person is taking, and other personal items that
might help during diagnostic testing. Be sure the physician has
all medical records, insurance and social security information.
Preparing for Diagnostic
Once the initial appointment has been made to evaluate
a person, the diagnostic team will need certain information to make
an accurate diagnosis. Pages 9 and 10 list Questions that you may
be asked by the diagnostic team, as well as questions that you may
want to ask regarding the diagnostic process. It may be helpful
to start writing down events that occur, and any changes in the
person's abilities, behavior and personality that cause you to suspect
Alzheimer's disease.
Questions You May Be Asked:
- What symptoms have you noticed?
- Difficulty performing simple tasks?
- Recent memory loss that affects job skills?
- Poor or decreased judgment?
- Others?
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When did the symptoms first appear?
- How have the symptoms changed over time?
- Does the person suffer from other medical conditions?
- Is the person taking any medications?
- Have other family members been diagnosed with Alzheimer's disease?
Questions To Ask Before Diagnostic Testing:
- Which tests will be performed?
- Will any of the tests involve pain or discomfort for the person?
- How long will the tests take?
- How long will it take to learn the results of the tests?
Questions To Ask If the Diagnosis Is Probable Alzheimer's
Disease?
- What does the diagnosis mean?
- What symptoms can be anticipated over time?
- What level of care will be required now and in the future?
- What medial treatment is available?
- What are the risks and effectiveness?
- What changes should be made in the home to make it safer?
- What resources and support services are available in our community?
- Are experimental drug trials available?
Alzheimer's disease is not currently preventable,
but science and medicine continue to make promising advances. Obtaining
an early and accurate diagnosis is an important strategy in helping
to improve the quality of life for persons with dementia and their
families.
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