Diagnosing Dementia

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.

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.

• 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.