How is Alzheimer’s Disease and Dementia Diagnosed?

Summary

In this episode of 'This is Getting Old,' Dr. Melissa Bachelor explains the process of diagnosing Alzheimer's and other types of dementia. She discusses the importance of ruling out other potential causes, highlighting essential steps like taking a thorough medical history, physical exams, cognitive screenings, blood tests, and brain scans. Dr. Bachelor emphasizes early diagnosis, as it helps manage symptoms, make lifestyle changes, and communicate future care plans. The episode also features a checklist for diagnosis and resources on Alzheimer’s symptoms and medication considerations, aiming to create a more age-friendly world for all.

Takeaways

• 😀 Early diagnosis of Alzheimer's disease is important because it helps rule out other conditions, allows for lifestyle modifications, and provides time to make future decisions.
• 😀 Alzheimer's disease and other dementias are diagnosed through a process of exclusion, where other reversible issues are ruled out through various tests.
• 😀 A comprehensive history, including lifestyle factors, family history, medical history, and surgical history, is key to diagnosing Alzheimer's disease.
• 😀 Social and lifestyle factors such as smoking, alcohol use, sleep, and exercise can impact memory and should be reviewed during diagnosis.
• 😀 Cognitive screenings are essential for detecting memory issues, depression, and cognitive impairments in Alzheimer’s disease, and they involve tests for orientation, language, reasoning, and memory.
• 😀 Medications, including over-the-counter drugs and supplements, should be reviewed, as some can contribute to memory problems or other cognitive impairments.
• 😀 Depression can mimic dementia symptoms, so it’s crucial to screen for depression as part of the diagnostic process for Alzheimer's disease.
• 😀 Cognitive screenings include tasks like drawing a clock, completing calculations, and naming objects, which help assess cognitive function.
• 😀 Blood work, such as tests for B12, thyroid levels, and kidney function, is important to rule out other conditions that may impact cognition.
• 😀 Brain scans like CT, MRI, PET, or SPECT scans can provide valuable insights into brain structure and activity, helping to differentiate Alzheimer’s from other conditions.
• 😀 A self-administered cognitive exam, such as the Jocogov exam, is a helpful online tool for assessing cognitive health at home, though professional diagnosis is still necessary.

Q & A

Why does it take time to get a diagnosis of Alzheimer's disease or dementia?

It takes time because dementia and Alzheimer's disease are diagnoses of exclusion, meaning doctors must rule out other conditions that might be reversible before confirming the diagnosis.

What are the six categories of tests and screenings necessary to diagnose Alzheimer's disease?

The six categories are: history (social, family, and medical), physical exam, medication reconciliation, cognitive screenings, blood work, and brain scans.

Why is early diagnosis of Alzheimer's disease important?

Early diagnosis is important because it allows for the identification of potentially treatable causes, lifestyle modifications to manage the disease, and provides time to plan for the future.

What are some modifiable lifestyle factors that can influence the diagnosis of dementia?

Modifiable factors include smoking, alcohol consumption, exercise, sleep quality, and social isolation.

What is the role of a family history in diagnosing Alzheimer's disease?

A family history of heart disease, diabetes, or Alzheimer's disease can provide important context, although lifestyle factors typically have a greater impact.

What does a physical exam for dementia diagnosis typically include?

A physical exam includes measuring vital signs, performing a head-to-toe exam, checking hearing and vision, and evaluating any sensory changes that might mimic memory issues.

How does medication reconciliation contribute to the diagnosis process?

Medication reconciliation ensures that all medications, including over-the-counter drugs and supplements, are reviewed to identify any that could be affecting memory or causing side effects.

What types of cognitive screenings are typically used to assess dementia?

Cognitive screenings assess orientation, language skills, reasoning and computation, abstraction, visual-spatial ability, executive function, and memory recall.

How does depression mimic dementia, and why is it important to differentiate the two?

Depression can cause symptoms similar to dementia, such as memory issues. Differentiating between the two is important because treating depression can improve memory and cognitive function.

What blood tests are typically done to rule out other causes of cognitive issues?

Blood tests include a complete blood count, basic metabolic panel, thyroid function tests, B12, and folate levels to check for deficiencies or underlying conditions that could cause memory problems.

What types of brain scans are used in diagnosing Alzheimer's disease?

Brain scans may include CT or MRI to look for brain shrinkage, PET scans to measure brain activity and protein deposits, or SPECT scans to assess blood flow and brain activity.

What is the significance of the clock drawing test in cognitive screenings?

The clock drawing test assesses a person's visual-spatial ability and executive function. Difficulty in placing the numbers and hands of a clock correctly can indicate cognitive issues.