As of 2014 2016 2017, there is no way to definitively diagnose Alzheimer’s disease on a living person – only upon autopsy. There are, however, several ways to eliminate other potential causes of dementia. Sometimes, when memory impairment is more advanced, doctors are able to confidently make a diagnosis without much testing. However, when a person is in the earlier stages of dementia an accurate diagnosis typically involves a battery of tests.
The first goal: Eliminate everything but Alzheimer’s
The primary doctor must first check the overall health of the patient. They will check reflexes, balance, blood pressure, sense of sight and hearing, etc. Lab tests will be run to exclude vitamin deficiencies and thyroid disorders that may cause memory problems.
A thorough review of all medications being taken by the patient along with an evaluation of family medical history will help the doctor in a diagnosis.
If you haven’t already, check out these two resources to help prepare yourself:
1) My Medicine Record
2) Family Medical History
Even the caregiver gets quizzed
The doctor should ask the caregiver (you) about the symptoms and their frequency. There are different variations of questionnaires used for this assessment. Here are 2 of the more common:
1) Functional Activities Assessment Tool Example
2) IQCODE
This is a good time to present the cognitive questionnaire that was discussed in my article, Memory Problems? 6 Ways to Prepare for the Doctor .
Let the Memory Tests Begin
The doctor will likely perform what is referred to as the mini-cog test. This quick test involves three steps. First the doctor asks the patient to repeat three words such as car, apple, and pencil. The doctor will then ask the patient to draw a clock. That’s right a clock.
Alzheimer’s disease is more than just a memory problem, so sometimes people with Alzheimer’s often have a hard time placing the numbers and hands in the correct location. Follow this link to see images of improperly drawn clocks.
Finally, the doctor will ask the patient to repeat the three words.
While this test is not 100% accurate, apparently it is a good indicator. It seems obvious to me that a person that can’t draw a clock accurately has something amiss. On the other hand, I have heard of severe dementia patients that can still draw a clock accurately.
Let the Memory Tests Continue
Depending on the doctor, the patient may be asked to take the mini-mental state test. This 30 point test takes less than 10 minutes. It asks questions like “what month is it” or “what city are we in”. The patient will also be asked to identify common objects and follow basic commands. This test may be administered multiple times over the course of the disease to allow the doctor to track the rate of decline.
Examples of this test can be seen at: Mini-mental State Test.
I would like to mention that I have read several accounts that taking these tests yearly adds a lot of stress to a person that has Alzheimer’s. At some point, one has to ask if it’s worth it? After all, if you are the primary caregiver don’t you already know if they are declining? Just saying…
At this point, if the doctor suspects Alzheimer’s Disease, they should refer your loved one to a specialist that is qualified to perform more in-depth testing that I will cover in my next article:
Testing for Alzheimer’s Disease, Part 2
If you would like some additional reading material on this topic, read this well-written article by the NIH: Diagnosing Alzheimer’s Disease.
Questions, stories, or comments? I would love to hear any input or experiences that you may have in the comments section below.
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A reader on Linkedin shared the following comment that I believe is important to pass on: “There are a lot of other tests out there, the Montreal Cognitive Assessment for example. It’s shown to be sensitive to picking up MCI where the MMSE has shown the opposite. There’s also a lot of new research out in the past year, including, a behavioral inventory. There is the thought there that mild behavioral changes are going to be far more sensitive as early signs than memory tests, dubbing these changes “Mild Behavioral Impairment” (MBI). We can especially appreciate this because it removes the focus from memory. http://www.medscape.com/viewarticle/866652 for info on MBI.