How Is Dementia Diagnosed in the Elderly?
Many older adults, as well as those who care about them, are watchful for signs that normal forgetfulness could be something more – such as dementia. Noticing and addressing dementia early can result in multiple benefits for adults, including making it easier to treat reversible causes of dementia and allowing for more time to find proper support. But what do you do after you notice the early signs of dementia? How is dementia diagnosed in the elderly and how do you know a doctor is approaching the issue responsibly?
Typically, a dementia diagnosis comes after multiple visits or one extended visit involving a doctor, the individual experiencing symptoms and often their immediate family members or close friends.
To diagnose dementia, doctors look for declining cognitive function, including problems with attention and memory, and evidence that these problems are impacting the person’s everyday life.
To determine whether the person’s difficulties are attributable to dementia, the physician will compare the individual’s current and past abilities. The doctor will also consider whether any reversible conditions, such as vitamin deficiency or medication side effects, might be causing the symptoms.
How a Dementia Diagnosis Happens
While evaluating symptoms and comparing them to past abilities is the first step in a formal dementia diagnosis, there are several other steps doctors will take to confirm their (and your) suspicions.
Ruling Out Other Causes
Research suggests that as much as 15 percent of dementia cases are misdiagnosed. Dementia is extremely difficult to diagnose accurately, simply because dementia symptoms are so similar to other conditions common in older adults.
Scientists are working on identifying biomarkers to confirm the diagnosis of Alzheimer’s disease, the most common type of dementia, and other forms of the disease. Until one is confirmed, there will always be a risk that someone will receive a dementia diagnosis when they shouldn’t, or not receive one when they should. Illnesses and conditions that can masquerade as dementia include:
- Clinical depression and other mood disorders
- Vitamin B12 deficiency
- Chronic fatigue syndrome
- Substance use disorder
- Brain tumors
- Traumatic brain injury (TBI)
Fortunately, many of these conditions are easier to confirm or rule out with clinical testing. If a doctor can rule out all of them, whether from testing or because symptoms don’t match, an accurate dementia diagnosis is more likely.
Tests and Evaluations – How Doctors Develop a Diagnosis
As a relative, friend or care partner, you should be aware that very few medical professionals will be able to diagnose dementia through a single test or interview with the individual. No matter how thorough, no single test can provide the kind of long view that’s necessary to diagnose dementia reliably.
Most doctors will use a combination of clinical tests and interview techniques to determine whether your relative or friend has dementia.
Brain Imaging Tests
Because clinical dementia involves physical changes in the brain, imaging studies can help distinguish it from other types of cognitive decline. Commonly recommended tests include:
- Temporal lobe MRI, which can differentiate dementia from depression and other disorders
- Structural MRI, which can confirm Alzheimer’s symptoms and aid in the diagnosis of other dementias
- Positron emission tomography (PET), which can identify metabolism patterns associated with different conditions that cause dementia
- Single-photon emission CT (SPECT), which studies blood flow to the brain
You don’t need to understand all these tests and how they work, but you should understand that imaging tests are accepted as supplemental tools and not primary sources of diagnostic information. Even if these tests are used, a doctor will still likely conduct physical exams and detailed interviews and medical testing to make a dementia diagnosis.
Physical Exam Procedures
Routine medical testing, like the kind you receive in the doctor’s office at a check-up or sick visit, can also help a doctor to diagnose dementia. Examples include:
- Blood pressure checks
- Lab tests using blood or urine samples
- Reflex and coordination tests
- Speech and sensation evaluations
There are other tests that a doctor might perform in order to diagnose dementia. You should feel comfortable asking how the test relates to the dementia diagnosis.
Interviews and Questionnaires
Doctors interview the individual to determine not only what their symptoms are but also how aware they are of those symptoms. Tests you might encounter include:
- The Mini-Cog test, in which the doctor asks the individual to draw a clock face correctly and repeat the names of three everyday objects. This test is often used to determine whether further testing is necessary.
- The Mini-Mental State Exam, which is a series of questions with a maximum score of 30 points. Scores of 24 or lower indicate the probability of dementia.
- The Abbreviated Mental Test, which is a standard tool for evaluating mental impairment in older adults.
- An FDA-approved computerized test like the Cantab Mobile, Cognivue or Automated Neuropsychological Assessment Metrics (ANAM), are frequently used as supplemental assessments of cognitive ability.
Most doctors will interview the individual as part of the diagnostic process, assuming that the person’s dementia is not too far advanced. However, current best practices mean that relatives, friends and care partners will probably need to offer information as well. As an outside observer that has experience with the person’s usual abilities, you are a valuable source of information.
Family Members and Friends as Resources
Self-report questionnaires and interviews can be difficult to conduct when a person has dementia, particularly if they are ill or struggling with more severe symptoms. For that reason, many doctors choose to speak in depth with relatives, friends or caregivers.
One tool you might see as a relative or friend is the Informant Questionnaire on Cognitive Decline in the Elderly, or IQCODE. Its shorter form poses 16 questions that ask about the course of decline, as opposed to the person’s current level of functioning. Research has shown that this questionnaire, when considered alongside a cognitive assessment, can help doctors to better understand the course of a person’s cognitive decline.
What else might doctors ask?
The doctor will also ask about medication routines. Many medications have side effects, like memory loss and confusion, that can look a lot like dementia. The more questions and tests your doctor performs, the more confident you can be that they have considered the person’s physiology, cognitive performance and history. Physicians are experienced with dementia, and understand when a test is necessary as well as when to refer you to a specialist for more information.
What to Bring to a Doctor’s Appointment as a Care Partner
If you suspect that a family member or friend has dementia, you can help the person’s physician make an accurate diagnosis by coming prepared.
- Get copies of the person’s medical records, especially lab results and brain imaging tests.
- Document behaviors and patterns that you’re worried about and bring that list to the doctor. Pay particular attention to how the person’s current abilities and behaviors are different from those they have shown in the past.
- Talk with other people who have regular contact with your relative or friend. That includes social contacts like friend groups as well as any routine care support the person may be receiving. Ask if they’ve noticed any of the patterns or behaviors that are worrying you.
- Bring documentation on any history of mental illness, especially depression or depressive symptoms, to all appointments. The same goes for other conditions, including but not limited to traumatic brain injury, that might cause dementia-like symptoms.
Diagnosing the Type of Dementia
Dementia is not a single disease. Medically, it can be more accurately described as a symptom set that belongs to a number of different disorders, each of which has different physiology.
The most common type of dementia is Alzheimer’s disease, which accounts for up to 80 percent of dementia diagnoses. Other types of dementia include:
- Vascular (stroke-related) dementia
- Frontotemporal dementia
- Lewy Body dementia
- Creutzfeldt-Jakob disease
If a doctor suggests that one of these conditions may be the cause of your relative’s or friend’s struggles, they will explain the condition in detail so you understand the nuances of the disease.
If your relative or friend does receive the diagnosis of Alzheimer’s disease or another type of dementia, you will need to sit down and decide together what happens next and in the future.
A time may come when the person needs to move somewhere they can receive 24-hour support and memory care in order to stay safe. Either or both of you may have strong feelings about this move.
In many cases, it can help to visit a few places and find one where your relative or friend can be safe and cared for as well as supported and encouraged to live a strong, healthy lifestyle. The Villages of Windcrest in Fredericksburg, Texas, is one place where people with dementia get the support they need to enjoy life and be respected as the experienced adults that they are. Feel free at any time to call and ask for more details. It can help just knowing that respectful dementia care is out there, and we’re always available to answer questions and help you find the best solution for your needs.