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How Dementia is Diagnosed, Tests & the Role of the Activities and Instrumental Activities of Daily Living

Last Updated: July 24, 2018

Could it be Dementia?

People in the earliest stages of dementia – especially Alzheimer’s disease (AD) – do not typically appear sick and are still able to perform most activities normally. Therefore, the disease often times goes unnoticed by close family members and coworkers. According to the 2018 Alzheimer’s Disease Facts and Figures report, research indicates that changes in the brain related to Alzheimer’s may start 20 years (or more) prior to symptoms of dementia appearing. With beginning changes, the brain makes up for the changes, allowing the individual to continue functioning as they normally would. However, as the disease progresses, the individual isn’t able to continue to compensate for the changes in the brain. That said, sometimes after diagnosis family members realize that their loved one has displayed behaviors that are amiss, such as using poor judgment in making decisions or withdrawing from social activities, for many years.

Generally, it is a significant change in behavior that prompts family members to take their loved one to the doctor’s office. When you initially notice or suspect dementia symptoms, you should talk to a doctor. Your loved one’s primary doctor may choose to make a referral to a neurologist, psychiatrist, geriatrician, or a clinic specializing in diagnosing and treating dementia, sometimes called a “memory” or “Alzheimers” clinic.

There are a few steps involved before a doctor can make a diagnosis of Alzheimer’s disease or a related dementia, such as Dementia with Lewy Bodies, Huntington’s Disease, and Parkinson’s Disease Dementia. The physician will ask you a series of questions and have your loved one perform tests to evaluate memory, thought, reasoning, communication, etc. Diagnostic tests, such as blood work and an MRI or CT scan are also likely.

 

Preparing to see a Doctor

The more you can tell the doctor about your loved one’s behavior, health, level of functioning, and any recent changes overall is helpful. To prepare for the initial doctor’s visit, it might be helpful to bring a list with the below mentioned information. Enlisting your loved one and others to help you prepare a list ahead of time will enable the doctor to make the most accurate diagnosis.

  • Medications: Prescription drugs, over-the-counter medications, and supplements your loved one is taking. Be sure to note information such as the name, dosage, and instructions for use (i.e. “take in the morning”) for each drug / supplement.
  • 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 Ability: Any changes in the way your loved one is able to perform Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs). (See below for more information on ADLs and IADLs.)
  • Personality Changes: Any personality changes, such as depression, irritability, or mood swings.
  • Other: Nutritional / diet patterns, as well as alcohol use and frequency.

 

Measuring One’s Ability to Function

As one’s stage of dementia progresses, one’s level of functioning diminishes, and the need for assistance with everyday living tasks becomes more commonplace. Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs) are commonly used as a means to measure one’s level of functioning. Persons with dementia may be able to perform these tasks independently, with some difficulty, or require assistance to complete them. However, as one’s stage of dementia becomes more advanced, the more difficult these tasks will become, and it is inevitable that assistance will be required. It is a good idea to take notes on the functional abilities of your loved ones and how they change over time. This information can be very helpful for one’s physician in better understand the progress, as well as diagnosing, the disease.

 

Activities of Daily Living

ADLs are the basic activities that one must perform on a daily basis in order to take care of oneself. Typically, ADLs refers to the following tasks:

  • Bathing (i.e., ability to bathe without assistance in washing or getting into the bathtub or shower)
  • Toilet Use (i.e., ability to use the toilet and clean oneself afterwards)
  • Control or Continence of Urine and Bowels (i.e., ability to wait for the right time and the right place)
  • Dressing and Grooming (i.e., ability to button a shirt, choose appropriate clothing)
  • Mobility (i.e., ability to move in and out of a chair or bed, walking)
  • Eating (i.e., ability to eat without having to be fed by someone else)

 

Instrumental Activities of Daily Living

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 Activities of Daily Living (ADLs). The following tasks are considered to be IADLs:

  • Managing Money (i.e., writing checks, handling cash, maintaining 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)
  • Extracurricular Activities (i.e., maintaining a hobby or some other pastimes)

 

Testing for Dementia

Unfortunately, there is no definitive test for diagnosing Alzheimer’s disease. If a form of dementia is suspected, the doctor will order a series of diagnostic testing to be performed to aid in making a diagnosis. Diagnostic examinations and testing typically include the following:

Medical History – The symptoms with which the patient is presenting, preesent and past health problems, psychiatric issues, and medications and family history of diseases.

Physical Exam – A physical exam helps to rule out other physical conditions, such as thyroid problems and side effects of medications that may be presenting similar to dementia.

Neurological Exam – This is an evaluation of the nervous system, which includes the brain, spinal cord, and neurons. The doctor will ask questions and have your loved one perform simple tasks to evaluate the following:

  • Coordination
  • Reflexes
  • Eye movements
  • Speech
  • Sensations (smell, touch, sound, etc.)

Mental Status Exam – The most commonly administered exam is the Mini-Mental State Exam (MMSE), which assesses several areas of mental wellness:

  • Orientation: Being aware of the day and year, knowing what town the individual is in, and being aware of who is president
  • Retention/Registration: Repeating the names of 3 objects
  • Attention: Counting backwards or figuring out a simple word problem
  • Recall: Recalling the names of 3 objects are a short time.
  • Language: Answering questions, repeating phrases, naming objects
  • Motor Skills: Copying a simple picture/drawing

Similar tests include the 6-question Blessed Orientation Memory Concentration test (evaluates awareness of time, short term memory, and thought) and the Clock Drawing Task, which involves drawing the face of a clock with all the numbers and the hands to set at a certain time.

Brain Imaging / Scans – The doctor may also order brain “scans,” which are basically pictures of the brain. There may be no evidence of early dementia in these scans, but later in the disease process, changes in the brain may be seen. The doctor may also use these tests to rule out another possible cause, such as a tumor or particular vitamin deficiencies, for your loved one’s symptoms. These tests are often used if vascular dementia is suspected. Types of brain scans include:

  • Computerized Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI) scan
  • Positron Emission Tomography (PET) scan

Laboratory Exam – A blood and urine sample will be taken in order to do the following:

  • Determine blood count
  • Rule out vitamin and / or nutrient deficiencies
  • Evaluate thyroid hormone levels (low levels may cause dementia symptoms)
  • Rule out other diseases, such as infections and diabetes

Other Options

Online Alzheimer’s Tests: While these tests are not a sufficient replacement for the abovementioned diagnostic tests, they are a good option for families who are questioning if a dementia diagnosis, and hence, a physician visit, might be warranted.

Alzheimer’s Blood Tests: Not yet currently an option, Alzheimer’s blood tests are being mentioned, as they are currently in development. Once available, these tests will be a huge breakthrough, as they will be able to detect Alzheimer’s disease prior to the display of dementia symptoms.

 

Making a Diagnosis

Once diagnostic testing has been completed, the doctor will review all information (medical history, physical, neurological, mental status, laboratory exams and brain scans) to make a diagnosis. For many forms of dementia, it is not possible for the doctor to say that someone “definitively” has a particular type of dementia. This is because making a definite diagnosis of many forms of dementia is only possible when an autopsy is performed (after death) to confirm the presence of damage or abnormal proteins in the brain.
However, the doctor will likely provide you with a diagnosis of probable or possible dementia. For example, for a person with symptoms of Alzheimer’s disease, the doctor may arrive at one of two conclusions:

  • Probable Alzheimer’s Disease: If the physical exam and test results match the criteria for diagnosing Alzheimer’s Disease.
  • Possible Alzheimer’s Disease: If the results demonstrate that the person has dementia, but it may differ from that of typical AD or be caused by another disease other than AD.

A person who is just starting to show small signs of dementia and does not display enough symptoms for a diagnosis of Alzheimer’s disease may be given a diagnosis of mild cognitive impairment.

 

Treating Dementia

After diagnosis, your physician will talk to you about a treatment plan that will best help your loved one. It is important to remember that there is not a cure for Alzheimer’s disease or for most forms of dementia. However, treatment may help slow down the progression of the disease and improve daily functioning, allowing more opportunities for quality time with your loved one.