Diagnosing Dementia

Did You Know

Caring.com has prepared a list of useful questions and information when talking to the doctor about a loved one who has just been diagnosed with Alzheimer's disease.

People in the earliest stages of dementia - especially Alzheimer's disease - do not typically appear sick and are able to perform most activities normally; therefore, the disease oftentimes goes unnoticed by close family members and coworkers. Some studies estimate that people experience symptoms from 3½ to 5½ years before being diagnosed (Gordeau and Hillier, 2005), although it may be even longer. Sometimes after diagnosis family members realize that their loved one has displayed strange or just "not quite right" behaviors for many years.

Generally, a significant change in behavior prompts family members to take their loved ones to the doctor's office. When you begin to notice or suspect dementia symptoms in your loved one, you should talk to your doctor or his or her doctor. Their regular doctor may choose to make a referral to a neurologist or psychiatrist or a clinic specializing in diagnosing and treating dementia, sometimes called a "memory" or "Alzheimers" clinic.

There are a few steps involved before the doctor makes a diagnosis. He/she will ask you a series of questions and ask your loved one to perform tests to evaluate memory, thought, reasoning, communication, and more. Your loved one will probably have to get some diagnostic tests, including bloodwork and an MRI or CT scan.

To prepare for the initial doctor's visit, it might be helpful to bring a list with the following information:

  • Medications: Any prescription and over-the-counter drugs or supplements that your loved one may be using. Be sure to note information such as the name, dosage, and instructions (i.e. "take in the morning") for each drug.
  • Health problems: Any recent changes in the health or behavior of your loved one, as well as any significant medical problems that he or she may have experienced in the past.
  • Behavior changes: Any recent changes in the behavior of your loved one, as well as any unusual behavior that he or she may have displayed in the past.
  • Changes in abilities: Any changes in the way your loved one is able to perform activities of daily living (ADLs)

    Activities of Daily Living (ADLs)

    Individuals with dementia may also need help with tasks that are called "Activities of Daily Living," or ADLs. ADLs are the basic activities that we must perform every day in order to take care of ourselves. Typically, ADLs refers to the following tasks:

    • Bathing (i.e., able to bathe without assistance in cleaning or getting into tub or shower)
    • Toilet Use (i.e., able to use the toilet and clean oneself afterwards)
    • Control or continence of urine and bowels (i.e., able to wait for the right time and the right place)
    • Dressing and grooming (i.e., able to button a shirt, choosing appropriate clothing)
    • Moving about (i.e., able to move in and out of a chair or bed, walking)
    • Eating (i.e., able to eat without having to be fed by another)

    Persons with dementia may be able to perform these tasks independently, with some difficulty, or with additional assistance. Their performance of these tasks is likely to change over time as well. It is a good idea to take notes on the abilities of your loved one and how he or she changes. The information can be shared with health professionals to help them better understand the progress of the disease in your loved one.

    or instrumental activities of daily living (IADLs).

    Instrumental Activities of Daily Living (IADLs)

    Many people with dementia will need help with tasks that are called "Instrumental Activities of Daily Living," or IADLs. IADLs are activities that we perform from day to day that add to our quality of life, but are not as basic to self-care as ADLs or activities of daily living. The following tasks are considered to be IADLs:

    • Managing money (i.e., writing checks, handling cash, keeping a budget)
    • Managing medications(i.e., taking the appropriate dose of medication at the right time)
    • Cooking (i.e., preparing meals or snacks, microwave/stove usage)
    • Housekeeping (i.e., performing light and heavy chores such as dusting or mowing the lawn)
    • Using appliances (i.e., using the telephone, television, or vacuum appropriately)
    • Shopping (i.e., purchasing, discerning between items)
    • Extracurriculars (i.e., maintaining a hobby or some leisure activities)

    Persons with dementia may be able to perform these tasks independently, with some difficulty, or with additional assistance. However, their performance might change over time as well. It is a good idea to take notes on the abilities of your loved ones and how they change. In this way, when you go to the physician, you can supply information that can help him or her better understand the progress of the disease.

  • Personality changes: Any personality changes, such as depression, irritability, or mood swings.

Enlisting your loved one and others to help you prepare this list ahead of time will enable the doctor to make the most accurate diagnosis. The link in the "Did You Know?" box (above) provides a handout that can help with this process.

View References Gordeau B, Hillier, J. Alzheimer's Essentials: Practical Skills for Caregivers. Carma Publishing. 2005.

Resources
Source: 
Alzheimer's Association
Description: 
This web page describes the steps to diagnosis, from finding the right doctor and reviewing medical history, to the tests typically given when making a diagnosis. The web page also discusses the downfalls of the many home screening tests that are available to consumers, and emphasizes that assessment and diagnosis must be performed by health care professionals.
Source: 
Alzheimer's Association
Description: 
This web page describes benefits of a timely diagnosis of Alzheimer's, which include better opportunities to build the right medical team and more time to plan for the future. It offers an opportunity to join the Alzeimer's Early Detection Alliance, to help spread awareness of Alzheimer's.
Source: 
Harvard Magazine
Description: 
This article discusses the importance of consulting a doctor after the first signs of memory loss and other conditions that mimic Alzheimer's disease.
Source: 
American Academy of Family Physicians
Description: 
This detailed medical article discusses aspects of making a diagnosis of dementia, including a guide to differential diagnosis in the form of a flow chart. The article is written for physicians.
Source: 
Alzheimer's Australia
Description: 
This compilation of web sites provides resources on general diagnosis information, information about different types of brain scans, laboratory & memory testing, and genes & genetic testing
Source: 
Mayo Clinic
Description: 
This article discusses issues regarding Alzheimer's diagnosis, including the warning signs, why people delay going to their doctor, why physicians may hesitate to make a diagnosis of Alzheimer's, and the benefits of early diagnosis.
Source: 
Alzheimer's Association
Description: 
This web page describes that an evaluation of individuals with symptoms of dementia is important because some causes of cognitive impairment are treatable or reversible. It also provides an overview of symptoms and diagnostic procedures.