How is Alzheimer’s Disease Diagnosed?

Early diagnosis and treatment of Alzheimer’s disease help bring the symptoms under control and improve the patient’s quality of life. Sadly, identifying the symptoms of Alzheimer’s disease is very challenging. In its early stages, symptoms of this condition usually go unnoticed. Without paying special attention and getting help from the people around you, you may never know that your cognitive functions are declining until the disease has progressed, and the symptoms have gotten worse. Some of the symptoms of Alzheimer’s can also pass off as typical signs of aging.

However, Alzheimer’s disease is not part of normal aging. Yes, some of the symptoms are similar, but there are some distinctions that you can use to know whether what you or a loved one is going through is aging or Alzheimer’s. For instance, forgetfulness is a common sign of aging, and it also happens in people with Alzheimer’s. However, its severity varies greatly, i.e., anyone who is aging normally will forget a few details, but they’ll still remember some information, e.g., names of close family members. On the other hand, a person with significantly progressed Alzheimer’s disease will forget even the most critical information about their lives, e.g., family history, the name of a loved one like kids, and a spouse.

Another challenge with the diagnosis of Alzheimer’s disease is that some of the symptoms can be mistaken for drug interactions or other medical conditions. This is a problem that healthcare professionals have to deal with every day. The good thing is several tests can identify dementia and Alzheimer’s disease.

Here are some of those tests:

Personal Medical History

The physician has to review your medical history to get a clearer picture of the symptoms you are experiencing and whether they could be related to Alzheimer’s. You will be asked about all the changes that you have experienced and when they started. The key changes the physician will be looking for are on personality, behavior, mood, and mental functions. Therefore, make sure to provide all the details while being as specific as possible. They can rule out the possibility that you are suffering from a totally different condition and help to pinpoint whether you are having Alzheimer’s or another form of dementia. You are encouraged to carry any sort of “evidence” that you feel will help the physician understand what you are going through. For instance, you can bring some checkbooks or letters where you made serious errors that could demonstrate your declining cognitive functions.

It’s also important to discuss any physical impairments you have been experiencing. This could include loss of coordination, weakness, and inability to do simple tasks like wearing clothes properly.

In addition to your medical history, it’s also vital to discuss your family medical history. Your genetics can put you at a higher risk of getting Alzheimer’s, so remember to tell the physician about any family members with a history of the same condition.

Finally, bring a list of all the medications that you may be using. Again, some symptoms occur due to drug interactions so maybe what you are experiencing is not dementia but a reaction to some of the drugs you are taking. The only way to know for sure is by letting your medical practitioner know what medications you’ve been taking.

It’s important to share all this information in very specific details without leaving anything out. This makes it easier for the physician to identify the possible diagnoses, do the relevant follow up tests, and get you on the necessary treatment as soon as possible. If it’s a loved one that you are worried about and not yourself, make sure to accompany them to the hospital and help the doctor get the necessary information.

Neurological Examinations

Neurological Examinations are vital for differentiating Alzheimer’s from other brain disorders. The physician may test your eye movement, pupil’s reaction, senses, speech, sensation, reflexes, and coordination to determine whether there is a problem in a specific part of your brain. For instance, your problem may be due to a degenerative disorder like Parkinson’s disease if you have tremors and other involuntary movements.

Mental Status Examinations

Mental status tests help look at your memory, problem-solving ability, concentration, and other cognitive functions. It allows the physician to determine whether you have dementia or delirium.

Mental status tests range from simple to somewhat complex. The physician could ask you to count backward from a certain number. You may also be asked to count backward in fives to see whether you can do it and how fast you do it. You will also get some tests on memorizing words or phrases, following written and spoken instructions, copying certain designs, and doing some simple calculations.

The physician will test your sense of awareness, like do you know where you are, what you are doing, time, date, and whether you know about the symptoms.

One of the most common mental status tests is the Mini-Mental State Exam (MMSE). In MMSE tests, you will be given a simple test with a maximum score of 30. This test evaluates the mental skills that we use on a daily basis. They will then use the test results to know how far your dementia has progressed. Here is a simple breakdown:

  • 20-24 score = Mild Dementia
  • 13-20 score = Moderate Dementia
  • Less than 12 score = Severe Dementia

Sometimes MMSE tests help tell the progress of a person with Alzheimer’s after starting treatment. Individuals with Alzheimer’s disease are usually expected to lose 2 to 4 points in this test every year.

Mini-Cog is another standard mental status examination that helps the physicians to know what additional examinations to do. This test involves only two tasks; One, draw a clock with all the numbers, and it should be showing the time specified by the physician. Second, you’ll be asked to remember certain names of some common objects, and then you’ll be asked to repeat the names a few minutes later.

Physicians will also perform mood assessments to rule out the possibility of depression, which is also known to affect memory in some cases.

Brain Scans

Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are always done during the diagnosis of the different types of dementia, including Alzheimer’s disease. These scans rule out the possibility of tumors, stroke, and hemorrhage that could be affecting the performance of your brain and causing Alzheimer’s-like symptoms.

In addition to ruling out other diagnoses, brain scans can also show the extent of Alzheimer’s disease by looking at the extent of brain mass loss.

Sometimes MRI and CT scans are not enough to make a definitive diagnosis. In such cases, physicians request additional brain scans, single-photon emission computed tomography, and positron emission tomography. These tests can confirm an Alzheimer’s disease diagnosis and rule out the possibility of other forms of dementia like Lewy Body and Frontotemporal dementia.

Genetic Tests

Physicians can use genetic tests that screen for specific genes that increase the risk of Alzheimer’s disease. For instance, studies have shown that gene APOE-e4 increases the risk of Alzheimer’s.

Deterministic genes are also known to cause Autosomal Dominant Alzheimer’s Disease (ADAD). This is a rare form of Alzheimer’s that tends to run in families.

Genetic testing of Alzheimer’s is quite controversial, especially the APOE-e4 tests. They are not recommended.

Other than the above tests, Alzheimer’s diagnosis can also include psychosocial evaluations, functional assessments, neuropsychological tests (conducted by neurologists and psychologists), and spinal tap or lumbar puncture.