Dementia: Making a Diagnosis
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When does absent-mindedness cross over into a serious illness like dementia? Is it when a person can no longer obey traffic signals? She can’t find her way home from the store? Or he can’t remember the basics of a household chore he’s been doing for years?
Dementia is an umbrella term describing problems with brain function that interfere with a person’s daily living activities.
Generally, you have dementia if you have two or more of the following symptoms:
- Memory loss
- Language and communication problems
- Inability to concentrate and pay attention
- Poor reasoning and judgment
- Lack of visual perception
Alzheimer’s disease is the most common type of dementia. Vascular dementia, often occurring after a stroke, is second most common and is related to problems with inadequate blood supply to the brain. There are also reversible causes of dementia that stem from conditions such as thyroid problems, depression, vitamin deficiencies and side effects from medications.
The process of diagnosing dementia generally begins when an individual is concerned about his or her memory and thinking abilities or a family member is concerned.
Steps to Diagnosis
Discussing your family history and having a physical exam with a physician is very important.
Your care team will look closely at medications, including over-the-counter medicines. A neurological exam is also very important to look for mild stroke in the past. You may also be tested for depression or have blood work done to check for vitamin deficiencies and thyroid, liver, and kidney function.
You may also be asked to take a 10-minute cognitive assessment test that measures skills such as language, visual/spatial abilities, memory, and abstract thinking. Sometimes, a more in-depth neuropsychological test is ordered that can take a couple of hours.
To look for brain changes that might cause thinking and memory issues, your doctor may order a CT scan or MRI to create images of the brain for study. Stroke, brain tumor, and abnormal fluid pressure in the brain are some of the possible findings that would cause brain dysfunction. The images also help doctors measure brain size and blood vessel changes that can be monitored over time.
One of the latest advances in diagnosis is an amyloid positron emission tomography (PET) scan, which detects abnormal protein fragments in the brain that form plaques and are associated with Alzheimer’s disease. The test is FDA-approved but generally not covered by insurance. Researchers continue to study the relationship between amyloid plaques and Alzheimer’s disease and how to best use the PET scan images for improved treatment.
Because there are various types and causes of dementia, there isn’t a single test or image that confirms the disease.
Why Diagnosis is Important
Diagnosis helps determine whether you or your loved one’s dementia is reversible or not. If it’s reversible, medication or treatment can be prescribed to address symptoms and the underlying cause of dementia.
If dementia is not reversible, as with Alzheimer’s disease, it is still good to know at an early stage that you have the disease. Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying Alzheimer’s process cannot be stopped or reversed.
Some benefits of early diagnosis for people with irreversible dementia and their families include:
- Getting the maximum benefit of available treatments to slow the progression of dementia, including participation in clinical trials
- Having time to plan for the future with input from the person who has dementia
- Getting legal and financial matters in order
- Putting household safety features in place
- Exploring alternate living options
- Developing support systems and finding resources
The biggest advantage is for the person with dementia to discuss what he or she wants later on concerning personal finances, business, and medical decisions. These are difficult but important discussions to have.
Answer a few questions and we'll provide you with a list of primary care providers that best fit your needs.
Source: Alzheimer’s Association; Family Caregiver Alliance; National Council on Aging
