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Tests and diagnosis
By Mayo Clinic staffMemory loss and other dementia symptoms have many causes, so diagnosis can be challenging and may require several doctor visits. Diagnosis involves a number of tests.
Medical history and physical exam
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Medical history. The doctor will ask about how and when symptoms began and about any health issues that may help identify the cause of the problem, for example diabetes, high blood pressure or a family history of dementia.
In addition, the doctor may request information from your caregiver or family member to find out whether your concerns represent a change from your earlier level of functioning.
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Physical examination. A physical exam helps your doctor rule out treatable causes of dementia and identify signs of stroke or other disorders that may cause similar symptoms. It also helps your doctor determine the best course of treatment. As part of an exam, your doctor may collect urine or blood samples, check blood pressure and review what medications you're using.
This examination can also help identify signs of other illnesses, such as heart disease, diabetes or thyroid abnormalities and any medication side effects, which can overlap with dementia.
Cognitive and neuropsychological tests
Anyone screened for dementia needs his or her cognitive function evaluated. A number of tests measure orientation, general intellectual skills, academic skills, language skills, spatial skills, attention, memory, reasoning and judgment. The goal is to determine whether dementia is present, how severe it is and what part of the brain is affected.
Neurological evaluation
This part of the examination evaluates balance, sensory function and reflexes to identify conditions that may affect the diagnosis or are treatable with medication.
Brain scans
A look at your brain can help your doctor identify strokes, tumors or other problems that can cause dementia. Alzheimer's disease changes brain structure over time and can also be seen with a brain scan. Several types of scans are used.
- CT and MRI scans. The most common imaging techniques for identifying dementia are computerized tomography (CT) and magnetic resonance imaging (MRI). A CT scan is an X-ray technique that produces images of your body that show internal structures in cross section. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues in your body. These scans help identify brain-size changes, strokes, and other problems such as excess fluid in the brain (hydrocephalus) or bleeding on the surface of the brain (subdural hematoma).
- Electroencephalogram (EEG). Using electrodes placed on your scalp, your doctor can detect and record patterns of electrical activity and check for abnormalities. If found, these abnormalities can indicate cognitive dysfunction, a condition common in people with moderate to severe Alzheimer's disease. An EEG may also detect seizures, Creutzfeldt-Jakob disease and other disorders associated with dementia.
Laboratory tests
A variety of lab tests can help rule out other conditions, such as kidney failure, that can contribute to symptoms. Treatable medical conditions are often associated with dementia. Medication and other treatments can improve many symptoms and quality of life.
Tests that help identify treatable medical conditions include:
- A complete blood count (CBC) to rule out anemia
- A blood glucose test to rule out diabetes
- Blood tests to estimate kidney function, to estimate liver function and to measure vitamin B-12 levels
- A blood or urine screen to identify drugs or alcohol
- Cerebrospinal fluid analysis (spinal tap) to rule out brain infections
- Analysis of thyroid and thyroid-stimulating hormone levels to rule out hypothyroidism
Psychiatric evaluation
This examination may be performed to determine whether depression or another psychiatric disorder is contributing to symptoms.
- Dementia: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dementias/detail_dementia.htm#1318919213. Accessed Jan. 25, 2010.
- Dementia. Alzheimer's Association. http://www.alz.org/alzheimers_disease_dementia.asp. Accessed Jan. 25, 2011.
- Alternative treatments. Alzheimer's Association. http://www.alz.org/alzheimers_disease_alternative_treatments.asp. Accessed Jan. 25, 2011.
- A guide to dementia diagnosis and treatment. The American Geriatrics Society. http://www.americangeriatrics.org/press/listservs/december_10_2010427672/id:1442 Accessed Jan. 25, 2011.
- NIH State-of-the-science conference statement on preventing Alzheimer's disease and cognitive decline. National Institutes of Health. http://consensus.nih.gov/2010/docs/alz/alz_stmt.pdf. Accessed Jan. 7, 2011.
- Ritchie K, et al. Designing prevention programmes to reduce incidence of dementia: Prospective cohort study of modifiable risk factors. British Medical Journal. 2010;341:c3885.
- Rusanen M, et al. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Archives of Internal Medicine. In press. Accessed Jan. 25, 2011.
- Siedlecki KL, et al. Comparison of patient and caregiver reports of patient activity participation and its relationship to mental health in patients with Alzheimer's disease. Journal of Gerontology: Psychological Services. 2009;64B:687.
- Scarmeas N, et al. Physical activity, diet, and risk of Alzheimer's disease. Journal of the American Medical Association. 2009;302:627.
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