How do I get a diagnosis?

Making the diagnosis

There is currently no single test that can tell if a person has Alzheimer's disease. The diagnosis is made through a systematic assessment that eliminates other possible causes. Until the time when there is a conclusive test, doctors will continue to use the words "probable Alzheimer's disease". Don't let these words fool you; doctors making this diagnosis are accurate 80 to 90 per cent of the time.

Making the diagnosis can take time. The diagnosis can be made in a family doctor's office, a memory clinic, a hospital, or in the community. The doctor may or may not feel that the person needs to see a number of health care professionals to help make the diagnosis. These may include a psychologist, psychiatrist, neurologist, geriatrician, nurse, social worker, or occupational therapist. They will look for problems with the person's memory, reasoning ability, language, judgement, and how these affect day-to-day function.

The process involves:

Medical history

Both individual and family members or friends will be asked questions regarding the person's symptoms now and in the past. There will be questions about past illnesses and about family, medical, and psychiatric history.

Mental status exam

This part of the process tests the person's sense of time and place, as well as the ability to remember, express him/herself, and do simple calculations. It may involve exercises such as recalling words and objects, drawing and spelling, and questions such as "What year is it?";

Physical exam

To help rule out other causes, a physical exam will be done. The doctor will look for heart, lung, liver, kidney, or thyroid problems that may be causing the symptoms. To evaluate whether other nervous system disorders are causing the symptoms, the doctor will test muscle tone and strength, co-ordination, eye movement, speech, and sensation.

Laboratory tests

A number of tests will be done. Detailed blood work will be ordered to help detect problems such as anemia, diabetes, thyroid problems, or infection that might be causing the symptoms.

Other tests such as X-rays and EEG's (electroencephalogram) may be used to determine the source of the problem. In some centres, scans may be used. These may be recommended, but are not always necessary for diagnosis:
CT (computerized tomography) scan and MRI (magnetic resonance imaging) take images of the brain. SPECT (single proton emission computed tomography) shows how blood is circulating to the brain. PET (positive electron tomography) shows how the different areas of the brain respond during certain activities such as reading and talking.

Psychiatric and psychological evaluations

A psychiatric evaluation may be helpful in ruling out other illnesses such as depression, which can cause memory loss similar to Alzheimer's disease. Neuropsychological testing can evaluate memory, reasoning, writing, etc.

Preparing for the assessment

On the day of the appointment, it will be useful to have the following information on hand. Writing this information down ahead of time can be helpful.

Things you will be asked:

• What symptoms have been noticed?
• When did they first appear?
• How have the symptoms changed over time?
• What medications are currently being taken?
• What other medical conditions does the person have?
• Is there a family history of Alzheimer's disease, "senility";, "hardening of the arteries";, neurological, or psychiatric conditions?

Things you may want to ask

• Which tests will be performed? What is involved in the tests?
• How long will the tests take?
• How long will it take to learn the results?
• How do we learn the results? Who will be involved?

The family's role

Sometimes the person experiencing the problems will go to see his or her doctor. For others, the family will play a role in alerting the doctor of a problem if the person is reluctant to seek help.

Tips to lend a hand

• Make the appointment for the person· Share this information with other family members · Help with transportation· Help prepare information for the first appointment
• Offer to accompany the person to appointments and tests
• Appreciate that this can be an unsettling time for the person and provide emotional support
• Have patience; it can take a long period of time to arrive at a diagnosis

If the diagnosis is Alzheimer's disease

You may want to ask:

• What does this diagnosis mean?
• What can be expected over time?
• What care will be needed and is available, now and in the future?
• What treatment is available? What are the risks and benefits?
• What resources are available in the community to help?
• Are there any experimental drug trials to participate in?

Finding support

Please call your local Alzheimer Society at any time in the process for additional information, community referral or support.

Source: Getting a Diagnosis: Finding Out If It Is Alzheimer's Disease - Alzheimer Society Canada.