How Is Dementia Diagnosed?

Answers to Common Questions You May Have

Doctor talking to senior patient
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If you've been experiencing symptoms of dementia, such as forgetfulness, a hard time finding the right words, or feeling so distracted that daily tasks such as making coffee are difficult, be aware that there could be multiple causes. Understanding the process of how dementia is diagnosed may help ease some of the concern you're feeling.

Due to your concern, you may want to monitor yourself for how often you notice these memory and thinking problems, as well as ask a family member or close friend if, and how often, they've noticed them as well.

You may also want to be screened for possible dementia. A screening is not the same as a definite test, such as a blood test, where a specific factor is assessed and the results are conclusive. A screening is a short and efficient way to evaluate if there's enough of a concern to warrant further testing.

Finally, you should contact your doctor to set up an appointment to further evaluate your cognition. Even though you may want to ignore these symptoms and hope they go away, it's generally best to get them checked out sooner rather than later so that you have the answers and treatment you need. Let's review a few common questions you may have about your visit.

Can I Screen Myself for Dementia at Home?

There is a screening test called the SAGE that is available online for people to use in the comfort of their own homes. You can take the test at home and see how you do, but be aware that the results should be brought to a physician for review.

Should I Go to My Regular Doctor or to a Specialist?

Usually, you will want to start with your primary care physician. Some primary care physicians will handle this evaluation completely themselves, while others will refer you to a specialist in the area of memory and cognition.

Some communities have memory loss or neurological clinics that specialize in the testing, diagnosis, and treatment of these concerns, and these clinics can be a valuable resource.

If this service is available in your community, be sure to call ahead to find out if a referral is needed from your primary care physician or if you can schedule an appointment directly with the clinic.

Can I Go to the Doctor's Appointment Alone, or Should I Bring Someone With Me?

While you can, of course, go alone to the doctor, it is often very helpful to bring someone else with you so that more than one person is hearing the doctor's words and can help you ask questions. Because going to the doctor can sometimes be a stressful experience, especially when you're worried, having someone else there to support you can be very beneficial.

Is There One Specific Test for Dementia?

No. Dementia is really a general term for the process of decline in mental abilities. If your appointment at the doctor's office shows that you have several symptoms of dementia, the next step for the physician is to consider what is causing those symptoms.

There are several kinds of dementia and further testing may help clarify the specific type you have. This can help direct effective treatment and help you develop appropriate expectations for how the dementia may progress over time.

What Kinds of Tests Might Be Performed?

The tests that your doctor orders will depend on what other symptoms you're having, in addition to the changes in your cognitive abilities.

The goal with testing is to learn more about what is causing your problems.

For example, sometimes testing can identify possibly treatable causes for your symptoms, such as a low amount of vitamin B12, which can then be supplemented and may improve your mental functioning.

You can expect several of the following tests and questions:

  • Dementia screening—Your doctor may use a test such as the MMSE, Mini-Cog, SLUMS, or MoCA. These cognitive tests can provide a snapshot of your cognitive functioning.
  • Review of your physical symptoms—You should share with your doctor any symptoms you're having, in addition to your memory and though process difficulties. This includes things like changes in balance or walking, coordination, activity level, and overall health.
  • Review of medications—Bring a complete list of the medications that you're taking with you. This includes any over-the-counter supplements or natural products you're taking, since too many medications (or the wrong combination of drugs) can cause symptoms that mimic dementia).
  • Blood tests—Your doctor may order blood tests that measure several areas, including thyroid functioning, signs of an infection, and certain vitamin levels.
  • Imaging scans—An MRI, CT, or PET scan may be ordered to rule out other causes of cognitive problems.
  • Psychological screening—Your physician may also ask you questions about your emotional state since depression and anxiety can affect cognitive functioning.

What Might the Doctor Say When He Gives Me a Diagnosis?

Sometimes, the diagnosis from the doctor is labeled as a specific kind of dementia. Other physicians, however, will simply leave the diagnosis at "dementia," instead of labeling it as a specific type such as  Alzheimer's, Lewy body dementia, vascular dementia, or frontotemporal dementia. This is because it can be difficult to determine which type is actually causing the symptoms.

In some cases, the dementia symptoms may also be caused by more than one medical condition, such as the case of mixed dementia. Mixed dementia is diagnosed when it's suspected or known that two or more diseases are causing the dementia, such as a combination of Alzheimer's and vascular dementia.

What If It's Not Dementia?

If your doctor determines that you don't have dementia you'll likely feel a significant sense of relief. Understanding whatever it is that has caused you to have these symptoms of memory loss can be very helpful in moving forward and making lifestyle and treatment decisions that may improve your symptoms.

Keep in mind that the strategies for reducing your risk of dementia often overlap with improving your overall health.

Why Should I Get Diagnosed If Dementia Isn't Treatable?

Some people feel like they'd rather not know if they have dementia if there's no cure available at this time. However, there are several benefits of an early diagnosis. It's even possible that your symptoms could be from a reversible condition that, once treated appropriately, could improve. Most people would not want to miss that opportunity.

Even though receiving a dementia diagnosis is difficult, it can also help explain why you've been having a harder time with your memory or decisions lately. Some people report feeling relief in knowing the cause of these problems.

There's also a benefit to knowing about your dementia so you can take the opportunity to make decisions for your future and communicate them to those around you. This is a gift to yourself and to your loved ones because it ensures that your choices and preferences are honored, and it also prevents your family members from having to guess about what you want.

What Should I Do If I Have Dementia?

Receiving the news of a dementia diagnosis isn't a great surprise for some people. They may have been suspecting it along the way. But, for many, this news is difficult.

You will likely need to spend some time grieving. The process of grieving often looks different for different people, but it may involve crying, writing out your feelings of sadness and disbelief, or just talking with a loved one. It's normal to need some time and support as you cope with a diagnosis.

It's important to understand that there should not be any shame or blame in this disease. Getting involved with a support group through your local Alzheimer's Association can be very helpful in understanding how to move forward as you adjust to life. Remember that you are not at fault, and that life can go on despite your diagnosis.

Is There Hope for a Dementia Cure?

It's true that dementia is generally not reversible at this time. However, there are things that you can do to help yourself. What foods you eat, how mentally active you are, and how much physical activity you choose to participate in all affect your state of health—both physical and cognitive. Much research has been conducted on these lifestyle choices and the conclusions have repeatedly shown that they can all play a role in your cognitive functioning.

There are also a handful of medications that are approved to treat Alzheimer's disease. Some of those medications have been somewhat helpful in other types of dementia. Research generally suggests that earlier treatment is better and may have the potential to delay the progression of symptoms for a limited time.

Additionally, several people who are living with dementia report that quality of life is possible, despite their diagnosis. This often involves social interaction with friends and opportunities for meaningful activities.

What If I Think the Doctor Made a Mistake?

One of the common reactions to a difficult situation is denial. It's not unusual to say, "I can't believe this is happening." Or, "I don't think this is correct. It's got to be something else." While this questioning may be a part of the grieving process of this diagnosis, it could also have its merits.

It's not a bad idea to get a second opinion. Occasionally, there have been misdiagnoses of dementia, when in truth the mental challenges were caused by something else that could be treated and at least partially reversed.

There are many possible causes of forgetfulness, and some of them are due to conditions such as stress, fatigue, or depression. Properly addressing them can result in significant improvements in cognitive functioning.

If a second opinion provides you with some peace of mind, it may be well worth it, even if it doesn't change the diagnosis.

What Questions Should I Ask After Getting a Dementia Diagnosis?

You should feel free to ask your doctor any questions you have about dementia and your diagnosis. These 12 questions are a good place to start, but it's normal to have several waves of questions as you begin to adjust. Take time to write them down as you think of them so that you can address them at your next doctor's visit.

Sources:

Alzheimer's Association. Dementia – signs, symptoms, causes, tests, treatment, care. http://www.alz.org/what-is-dementia.asp

Alzheimer's Association. Diagnosis of Alzheimer’s & dementia. http://www.alz.org/alzheimers_disease_diagnosis.asp. 

Alzheimer Society of Canada. Alzheimer's Disease. Getting a Diagnosis. http://www.alzheimer.ca/~/media/Files/national/Core-lit-brochures/Getting_a_Diagnosis_e.pdf

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