The Alzheimer's Digest: Five tools help medical professionals diagnose dementia.

If you’re wondering if dementia is the cause of your loved one’s changed behaviors, the only way to know for sure is to get a diagnosis at a geriatric assessment center. Professionals from diverse specialties representing neurology, speech pathology, social work, and psychiatry will use up to five tools to make a diagnosis.

1. Medical history

Medical history involves an initial interview.

The geriatric assessment team will review your loved one’s medical records then conduct an initial interview. Doctors can better diagnose when they’re aware of your family’s health history. The interview also includes questions about diet and nutrition, lifestyle choices such as alcohol use, and depression.

Age is a contributing factor.

The risk of being diagnosed with dementia doubles every five years after age sixty-five until age eighty-five. There’s an almost 50-50 risk of being diagnosed with dementia after age eighty-five.

Because dementia is considered an older-person’s disease; oftentimes, a younger person’s symptoms of cognitive impairment are UNlikely to be diagnosed until it’s too late for families to plan for the debilitating diagnosis of early onset dementia.

2. Mental acuity

The next part of the assessment includes a mental acuity test.

The Mini Mental State Evaluation (MMSE) or similar assessment helps professionals assess one’s cognitive abilities. Questions focus on one’s ability to tell the time, date, and place. Additionally, part of the assessment includes counting backwards and even following simple movement commands.

Ohio State University developed a version of the MMSE, which includes questions such as:

What is today’s date –month, date, and year? No cheating! Can’t peek at a calendar.

How many nickels are in 60 cents?

Draw a large face of a clock and write in the numbers. Position the hands for five minutes after 11 o’clock.

A shorter version of the MMSE, the Mini Cog, asks participants to identify three objects in the room, draw the face of a clock, and then recall the three items identified, earlier.

Then there’s the real challenge for those of us who suffer from test anxiety–spell WORLD backwards. Aaarrrrggghhh!

3. Physical + Lab tests + Neurological exam

This portion of the assessment includes checking vital signs (including blood pressure, temperature, and pulse) and blood chemistry to rule out dementia-like symptoms caused by medicines, a urinary tract infection, or other reversible cause.

Vision and hearing are also tested unless your loved one’s medical records include recent test results. When s/he can’t see or hear clearly, s/he withdraws. This contributes to loneliness and depression and may amplify dementia symptoms.

Finally, a neurologist will conduct tests for reflexes, coordination and strength, eye movement, speech, and sensation.

It’s easy to conclude a tremor is caused by Parkinson’s,
but could the tremor mean something else?

Just as a momentary “frozen” episode could be mistaken for vascular dementia,
could it be a TIA caused by high blood pressure, diabetes, or heart disease?

4. Imaging Tests—CT, MRIs, and Pet Scans

Imaging tests help the geriatric assessment team assess the physical properties of the brain. Is there shrinkage? How much blood is flowing to the different areas of the brain? A functional MRI (fMRI) allows specialists to determine the likely cause of impairment by viewing blood flow to certain areas of the brain while the patient performs specific tasks.

According to the Mayo Clinic, protein deposits called Lewy bodies,
develop in nerve cells in regions of the brain involved in
thinking, memory, and movement (motor control).
Clumps of alpha-synuclein protein that cluster are different from Parkinson’s.

A new radioactive dye—Florbetapir F18 or Amvid—is injected before a Positron emission tomography (PET) scan in the most difficult to diagnose cases, such as in younger patients with dementia or in patients with dementia that is rapidly progressing.

5. Gene testing

In rare situations where all other tests prove inconclusive, the team may suggest gene testing. Research is still grappling with which of the complex factors contribute to dementia. While the amyloid precursor protein (APP), presenilin-1 (PS-1), presenilin-2 (PS-2), and apolipoprotein E-e4 (APOE4) are the most researched, much remains yet to be learned.

Each of these tools–medical history, mental acuity, labs, imaging, and gene testing, are taken a step at a time. Most, will only need the first three.

For more information click on link to read each of these articles.