But basic tasks ARE harder as one ages, right? She’s getting older. Maybe I’m paranoid. Maybe she’s fine. How can I know?
People in the earliest stages of dementia – especially Alzheimer’s disease (AD) – do not typically appear sick, and can still perform most activities normally. The disease can therefore go unnoticed by close family members and coworkers.
For a while, the brain makes up for the changes, allowing someone to continue functioning normally. But as the disease progresses, the individual can’t keep compensating for changes in the brain. Family members often realize, after a diagnosis, that their loved one has displayed concerning behaviors – like using poor judgement or withdrawing from social activities – for many years.
Significant changes in behavior generally prompt a medical evaluation. When you initially notice or suspect dementia symptoms, you should talk to a primary-care doctor who can, if necessary, make a referral to a neurologist, psychiatrist, geriatrician, or a clinic specializing in diagnosing and treating dementia (sometimes called a “memory” or “Alzheimer’s” clinic).
There are some 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 questions and administer tests to evaluate memory, thought, reasoning, communication, etc. Diagnostic tests, such as blood work and an MRI or CT scan, are also likely.
Benefits of Seeking a Diagnosis
This can be a scary time, and some are reluctant to see a doctor because the news may be bad and there’s no cure for dementia anyway. But remember that treatment (including non-drug intervention) is highly effective for managing symptoms. It is also important to get all possible questions answered, and to prepare for the life changes that come as the disease advances. Doctors and other advisers can help with things like making the home safer, establishing routines, utilizing community services and resources, and possibly participating in clinical trials. Financial planning for at-home or residential care may be necessary. (Early diagnosis has been found to save money.)
Bottom line: Knowing is crucial. Do not put off addressing this serious situation.
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, the better. Make a list with the information below. Enlisting your loved one, and others, to help you prepare ahead of time enables an accurate diagnosis.
Medications: Prescription drugs, over-the-counter medications, and supplements your loved one is taking. Note information including the name, dosage, and instructions for use (i.e. “take in the morning”) for each drug and supplement.
As dementia progresses, 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 to measure how well one functions. Persons with dementia may be able to perform these tasks independently, with some difficulty. As dementia becomes more advanced, these tasks become difficult, and assistance will be required. Take notes on the functional abilities of your loved ones and how they change over time, with an eye on the following; this information can be very helpful for a physician to better diagnose and understand the progress of the disease.
ADLs are basic activities that one must perform to take care of oneself. Typically, ADLs are the following:
Many people with dementia need help with tasks called “Instrumental Activities of Daily Living,” or IADLs. These are activities we perform from day to day that are important, but not as basic to self-care as Activities of Daily Living (ADLs). Pay attention to how well your loved one performs these IADLs:
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 reach as conclusive a determination as possible. These examinations typically include the following:
Medical history: The patient’s symptoms, present and past health problems, psychiatric issues, medications, and family history of diseases.
Physical exam: A physical exam helps rule out other conditions, such as thyroid problems and side effects of medications, that may cause symptoms 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:
Mental Status Exam: The most common test is the Mini-Mental State Exam (MMSE), which assesses these areas of mental wellness:
Similar tests include the six-question Blessed Orientation Memory Concentration Test (evaluates awareness of time, short term memory, and thought) and the Clock Drawing Test, which involves drawing the face of a clock with all the numbers and the hands set at a certain time (usually 10 after 11).
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 changes in the brain become visible in the later stages. The doctor may also use these tests to rule out other possible causes of symptoms, such as a tumor or particular vitamin deficiencies. These tests are often ordered if vascular dementia is suspected. Types of brain scans include:
Laboratory exam: A blood and urine sample is taken for the following:
Online Alzheimer’s Tests: While these tests are not a sufficient replacement for the diagnostic tests mentioned above, they are a good option for families questioning if a physician visit might be warranted.
Alzheimer’s Blood Tests: Not yet an option, Alzheimer’s blood tests are mentioned here because they are currently in development. Once available, these tests will be a huge breakthrough, able to detect Alzheimer’s disease prior to the display of dementia symptoms.
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 “definitely” has a particular type of dementia. This is because making a definitive 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 can provide you with a diagnosis of probable or possible dementia. For a person with symptoms of Alzheimer’s disease, the doctor may arrive at one of two conclusions:
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.
After diagnosis, your physician will talk to you about the best treatment plan. There is not a cure for Alzheimer’s disease or most forms of dementia, but treatment may help slow the progression of the disease and improve daily functioning. Managing symptoms with the right treatment can give your loved one a shot at continuing to thrive, despite the disease.