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How Is Dementia Diagnosed?

If you have concerns, don’t put off the exam

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Some forgetting is normal at any age. Everybody misplaces their keys, right? But for some people, confusion gets pronounced, and simple tasks such as managing money and driving become difficult without assistance.

Although there is no vaccine or cure for dementia, early diagnosis is still crucial. Seeking help early and getting a diagnosis offer time to try therapies that may slow disease progression and relieve troublesome symptoms. Such actions also give the patient and family members time to anticipate care needs and plan financially.

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In the United States, as many as 6.7 million people are living with dementia, according to the Alzheimer’s Association. As the older population grows, those numbers are expected to rise sharply. The average age of onset is around 84 years.

When it comes to diagnosis, “there’s no specific blood test or brain scan to tell if you have dementia. We often make the diagnosis by bedside testing,” says geriatric psychiatrist Karen Severson, M.D., based in Jupiter, Florida. She’s referring to simple questions a doctor might ask or short cognitive tests to check a person’s ability to recall and communicate, such as drawing a clock face. Although she uses the term “bedside testing,” these evaluations more often happen during a visit to the doctor’s office.

Getting a dementia diagnosis

Symptoms of Dementia

Dementia shows up in many ways. Early symptoms may include:

  • Forgetting recent events
  • Repeating questions
  • Acting on impulse
  • Struggling with daily tasks
  • Changes in mood and personality
  • Poor judgment and bad choices
  • Inappropriate emotional outbursts
  • Loss of interest in everyday events
  • Losing track of time, place and people
  • Difficulties planning or problem-solving
  • Losing things or misplacing them oddly
  • Not caring about the feelings of others
  • Losing balance and movement problems
  • Trouble keeping track of money and paying bills
  • Hallucinations, delusions or paranoia

Step one is to share your concerns with your primary care doctor, who may do some testing or refer you to one or more specialists:​

  • Neurologist
  • Geriatrician​
  • Neuropsychologist
  • Geriatric psychiatrist

It’s a good idea to bring a family member along for the appointment to help answer questions, which will probably cover:

  • ​Your symptoms and how long you’ve had them
  • Personality or behavior changes​
  • Any medications you are taking (some drugs can cause dementia symptoms)​
  • Any medical conditions or recent surgeries (some have been tied to the onset of dementia symptoms)​
  • Family members with a similar history
  • Your general well-being, including sleep, appetite and any recent stress​
  • Changes in movement, such as slowed walking or tremors

The doctor may examine you for signs of other diseases, checking your:

  • Abdomen
  • Kidneys
  • Nerve function
  • Senses
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Certain tests and lab work may be performed:

  • Cognitive and neurological tests. Your thinking, memory, math skills, balance, reflexes and sensory responses are tested.
  • Blood tests. Blood samples may be taken to see whether the thyroid is working normally and to look for vitamin deficiencies. For one type of dementia, Alzheimer’s disease, blood tests are becoming available. They measure proteins, such as beta-amyloid, that are typical signs of Alzheimer’s. At present, blood tests are not enough to diagnose Alzheimer’s; they are considered with other evidence. They also don’t say anything about cognitive function.
  • Cerebrospinal fluid tests. The fluid surrounding your brain and spinal cord can be tested for the two Alzheimer’s-related proteins — beta-amyloid and tau — that can clump and form tangles.​
  • Brain scans. Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) look for changes in brain shape and size and patterns of altered brain activity that are common in dementia.
  • Mental health evaluation. A psychiatrist may help pinpoint symptoms that may be treatable with medications or cognitive behavioral therapy. An evaluation could also rule out depression.
  • Genetic tests. These can help to detect inherited conditions that raise the risk for dementia.​​

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Although your doctor can diagnose dementia without tests by measuring your memory, thinking and problem-solving abilities, lab work can help confirm the diagnosis and establish the type of dementia, which affects treatment options. Speak with your health care team if you want to get checked.

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