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Dementia: Making a Diagnosis

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

Larry Lawhorne, MD, Wright State Physicians — Geriatrics, in Dayton, Ohio, emphasizes the importance of a thorough history and physical exam. He talks extensively with a patient and family members together and then separates them for individual conversations. 

“We look closely at medications, including over-the-counter medicines,” he says. “A neurological exam is very important to look for mild stroke in the past. I also test for depression and do blood work to check for vitamin deficiencies and thyroid, liver and kidney function.”

Dr. Lawhorne also asks the person to take a 10-minute cognitive assessment test that measures skills such as language, visual/spatial abilities, memory and abstract thinking. 

Sometimes, he orders a more in-depth neuropsychological test that can take a couple of hours. He may already know a patient’s deficits, but this test can help him determine a patient’s strengths. “I can tell if it’s better for you to see something or hear something. Will you benefit from making lists? Will you tolerate your spouse doing things for you?” he explains.

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. 

Dr. Lawhorne says 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,” Dr. Lawhorne says. 

Source: Larry Lawhorne, MD, Wright State Physicians — Geriatrics, in Dayton, Ohio; Alzheimer’s Association; Family Caregiver Alliance; National Council on Aging