Finding the right doctor

The first step in following up on symptoms is finding a doctor you feel comfortable with. Alzheimer’s Association clients report they are most likely to be satisfied seeing someone who is well informed about Alzheimer’s disease. Your local Alzheimer’s Association can help you find the right doctor.

There is no single type of doctor who specializes in diagnosing and treating memory loss or Alzheimer’s disease. Many people contact their regular primary care physician or internist about their concerns. Primary care doctors often oversee the diagnostic process and provide treatment themselves.

In some cases, the primary care doctor may refer a patient to one of the following specialists:

• A neurologist, who specializes in diseases of the brain and nervous system

• A psychiatrist, who specializes in disorders that affect mood or the way the mind works

• A psychologist with advanced training in testing memory, concentration, problem solving, language and other mental functions

Understanding the problem

There is no single test that proves a person has Alzheimer’s. The medical workup is designed to evaluate overall health and identify any conditions that could affect how well the mind works.

Experts estimate a skilled physician can diagnose Alzheimer’s with more than 90 percent accuracy. Doctors can almost always determine that a person has dementia, but it may sometimes be difficult to pin down the exact cause.

Be prepared for the doctor to ask:

• What kind of symptoms have you noticed?

• When did they begin?

• How often do they happen?

• Have they gotten worse?

Dementia screening tests

An increasing number of test developers, health care facilities and others are marketing dementia screening tests directly to consumers. The Alzheimer's Association believes that home screening tests can not and should not be used as a substitute for a thorough examination by a skilled doctor. There is an established diagnostic criteria that physicians adhere to when evaluating someone for Alzheimer's disease.

Although dementia screening tests don't claim to offer a definitive diagnosis, any test that plants the idea of a serious illness has the potential to cause great psychological distress to the test taker. The whole process of assessment and diagnosis should be carried out within the context of an ongoing relationship with responsible health care professionals. 

Reviewing medical history

The doctor will interview the person being examined or family members to gather information about current and past illnesses. The doctor will also obtain a history of medical conditions affecting other family members, especially whether they may have had Alzheimer’s disease or a related disorder.

It is helpful to bring a list of all the medications the person is taking. The doctor will obtain a history of key medical conditions affecting other family members, especially whether they may have had Alzheimer's disease or related disorders.

Mental status tests

Mental status testing gives the doctor a general idea of whether a person:

• Is aware of having symptoms or feels nothing is wrong

• Knows the date, time and where he or she is

• Can remember a short list of words, follow instructions and do simple calculations

The mini-mental state examination (MMSE) is one of the tests most commonly used to assess mental function. In the MMSE, a health professional asks a patient a series of questions designed to test a range of everyday mental skills.

Examples of questions include:

• Remember and repeat a few minutes later the names of three common objects (for instance, horse, flower, penny)

• State the year, season, day of the week and date

• Count backward from 100 by 7s or spell “world” backwards

• Name two familiar objects present in the office as the examiner points to them

• Identify the location of the examiner’s office (state, city, street address, floor)

• Repeat a common phrase or saying after the examiner

• Copy a picture of two interlocking shapes

• Follow a three-part instruction, such as: take a piece of paper in your right hand, fold it in half, and place it on the floor

The maximum MMSE score is 30 points. A score of 20 - 24 suggests mild dementia, 13 - 20 suggests moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer’s declines about 2 - 4 points each year.

Another popular mental status test is the “mini-cog,” which involves two tasks: (1) remembering and a few minutes later repeating the names of three common objects, and (2) drawing a face of a clock showing all 12 numbers in the right places and a time specified by the examiner.

In addition to assessing mental status, the doctor will evaluate a person’s sense of well-being to detect depression or other mood disorders that can cause memory problems, loss of interest in life, and other symptoms that can overlap with dementia.

Physical exam and diagnostic tests

  The physician will

• Ask about diet, nutrition and use of alcohol.

• Review all medications. It is helpful to bring a list or the containers of all medicines currently being taken, including over-the-counter drugs and supplements.

• Check blood pressure, temperature and pulse.

• Listen to the heart and lungs.

• Collect samples of blood and urine.

Information from these tests can help identify other disorders that may cause memory loss, confused thinking, trouble focusing attention, or other symptoms similar to dementia. Such disorders include:

• Anemia, malnutrition or certain vitamin deficiencies

• Excess use of alcohol

• Medication side effects

• Certain infections

• Diabetes

• Kidney or liver disease

• Thyroid abnormalities

• Problems with the heart, lung or blood vessels

The neurological examination is an important part of the physical. Its goal is to assess the function of the brain and nervous system to identify symptoms of brain disorders other than Alzheimer’s.

During the neurological exam, the physician may test:

• Reflexes

• Coordination and balance

• Muscle tone and strength

• Eye movement

• Speech

• Sensation

Brain imaging

New imaging technologies have revolutionized our understanding of the structure and function of the living brain.

• Structural imaging provides information about the shape, position or volume of brain tissue. Structural techniques include magnetic resonance imaging (MRI) and computed tomography (CT).

• Functional imaging reveals how well cells in various brain regions are working by showing how actively the cells use sugar or oxygen. Functional techniques include positron emission tomography (PET) and functional MRI (fMRI).

Currently, a standard medical workup for Alzheimer’s disease often includes structural imaging with MRI or, less frequently, CT. These images are used primarily to detect tumors, evidence of small or large strokes, damage from severe head trauma or a buildup of fluid.

Researchers are studying whether the use of MRI and other imaging methods may be expanded to play a more direct role in diagnosing Alzheimer’s. Many studies have shown that the brains of people with Alzheimer’s shrink significantly as the disease progresses.

Research has also shown that shrinkage in specific brain regions may be an early sign of Alzheimer’s. However, scientists have not yet agreed upon standardized values that would establish the significance of a specific amount of shrinkage for any individual person at a single point in time.

Research with PET and other functional imaging methods also suggests that those with Alzheimer’s typically have reduced brain cell activity in certain regions. However, as with the shrinkage detected by structural imaging, there is not yet enough information to translate these general patterns of reduced activity into diagnostic information about individuals.

At this time, PET is used primarily in research studies in hopes of gaining further knowledge about its potential for wider use in diagnosing Alzheimer’s and monitoring progression and response to treatment.

Today, Medicare will cover a PET scan for Alzheimer’s only to help distinguish the disease from frontotemporal dementia, a rare related disorder that may cause dramatic loss of function in the front and side regions of the brain.

Another promising area of functional imaging research focuses on developing tracer compounds that will attach to key abnormal brain deposits implicated in Alzheimer’s. For example, preliminary data suggests that one such tracer, called Pittsburgh compound B, may attach to beta-amyloid and “light up” in a PET scan.