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

Last Updated: July 10, 2019

 It’s more than typical forgetfulness, worse than misplacing keys or mixing up a couple names. Those things are happening, but mom is also retreating inward, less interested in the fun activities that used to make her feel alive. Her personality has changed; she becomes aggravated. And basic tasks seem harder.

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?


Could it be Dementia?

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.

 Research indicates that changes in the brain related to Alzheimer’s may start 20 years (or more) prior to symptoms appearing.

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.

  • Health problems: Any recent changes in the health of your loved one, as well as any significant medical issues.
  • Behavior changes: Any recent changes in the behavior of your loved one, as well as any unusual past behaviors.
  • Changes in ability: Any changes in the way your loved one can perform Activities of Daily Living (ADLs) including bathing, toilet use, dressing and eating; and Independent Activities of Daily Living (IADLs) including managing money and medications, cooking, using appliances and shopping.
  • Personality changes: Changes including depression, irritability, or mood swings.
  • Other: Nutritional and diet patterns, including alcohol use and frequency.


Measuring Ability to Function

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.

Activities of Daily Living

ADLs are basic activities that one must perform to take care of oneself. Typically, ADLs are the following:

  • Bathing: Ability to bathe without assistance)
  • Toilet use: Ability to use the toilet and clean oneself afterwards.
  • Control or continence of urine and bowels: Ability to wait for the right time and the right place.
  • Dressing and grooming: Ability to button a shirt, and choose appropriate clothing.
  • Mobility: Ability to move in and out of a chair or bed; walking.
  • Eating: Ability to eat without having to be fed by someone else.

Instrumental Activities of Daily Living

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:

  • Managing money: Writing checks, handling cash, maintaining a budget.
  • Managing medications: Taking the appropriate dose of medication at the right time.
  • Cooking: Preparing meals or snacks; microwave/stove usage.
  • Housekeeping: Performing light and heavy chores such as dusting or mowing the lawn.
  • Using appliances: Using the telephone, microwave, or vacuum appropriately.
  • Shopping: Purchasing; discerning between items.
  • Extracurricular activities: Maintaining a hobby or 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 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:

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

Mental Status Exam: The most common test is the Mini-Mental State Exam (MMSE), which assesses these areas of mental wellness:

  • Orientation: Being aware of the day and year, knowing what town the individual is in, and knowing who is president.
  • Retention/registration: Remembering and reciting back three specific words.
  • Attention: Counting backwards or solving a simple word problem.
  • Language: Answering questions, repeating phrases, naming objects.
  • Motor skills: Copying a simple picture/drawing.

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:

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

Laboratory exam: A blood and urine sample is taken for 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 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.


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 “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:

  • Probable Alzheimer’s disease: If the physical exam and test results match the criteria for diagnosis.
  • 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 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.