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Getting a Diagnosis for Suspected Dementia

Can Alzheimer's Disease be Definitely Diagnosed?

Although a definitive diagnosis of Alzheimer's disease requires a brain tissue autopsy, it is not necessary to wait until after death to know with some certainty what is causing the symptoms and behaviors that accompany dementia. A clinical diagnosis of Alzheimer's disease includes:

  • a complete patient and family history
  • a physical examination
  • laboratory tests
  • assessment of medications
  • neurological examination
  • psychiatric assessment
  • neurological testing

Both the accuracy and availability of clinical diagnosis have improved in recent years. The results of research studies have shown that clinical diagnoses are more than 90 percent accurate when matched with patients' autopsy reports.

Why is Diagnosis Important?

First, it will pinpoint dementia caused by potentially reversible conditions, such as drug reactions, tumors, infections, thyroid problems or nutritional deficiencies. In some cases, when these conditions are treated the dementia may go away. It is important to remember that even reversible conditions, if left undetected and therefore untreated, can cause permanent damage.

Second, early diagnosis, when the symptoms of dementia are mild, allows the patient and caregiver to adjust to the diagnosis, learn about the disease and resources and plan for the future. Also, there are currently four medications that are available to slow down the progress of the disease.

Third, in instances when the dementia is irreversible, clinical diagnosis also will be able to identify the presence of other medical problems, which may be compounding the Alzheimer's disease. The quality of life for the patient can be greatly enhanced if treatable conditions are controlled.

What if My Relative Doesn't Want to Go to the Doctor?

When a relative begins having memory problems, family members are understandably concerned. Sometimes the person with memory problems knows something is wrong and seeks to cover up and/or deny the problem(s). Conversely, some individuals have no self-awareness of their memory problems and really do not understand what their family is upset about. The family may then encounter varying degrees of resistance to go to a doctor for a check-up or diagnosis.

Here are some suggestions:

  1. Tell the relative that it is time for a good check up. You do not necessarily need to discuss that you are concerned about the person's memory problems.
  2. If the relative has had a physician for a long time, ask if his/her office will call to remind your relative that it's time for a visit.
  3. If your relative has any other medical conditions or illnesses, encourage him/her to see the doctor for these conditions. Make sure you talk with the doctor beforehand about your concerns.
  4. Ask another trusted family member or friend to help encourage the person to go to the doctor.
  5. Have two family members or friends go with the person to the appointment.
  6. Pick the time of day when your relative is functioning best. Allow plenty of time for getting ready, getting out of the house, traveling and parking.
  7. Bring something to distract or comfort the person while you are waiting, such as a snack, book, pictures, etc.
  8. Take a walk or drive if the receptionist says there will be a long wait.
  9. If necessary, make prior arrangements with the doctor to consider the you or the assisting family member as the patient. Once there, have the doctor first talk to you, take your blood pressure, etc., then gradually direct attention to the person with memory loss.
  10. If necessary, do not ask if he/she wants to go to the doctor. Make an appointment and present this to him/her: "Tuesday we are going to the doctor." Depending on the individual, you may want to do this a week before, the day before, an hour before, or just as you are getting into the car.

While it may not be easy, it is in your family member's best interest to see the physician. If he/she does have Alzheimer's disease or a related dementia, your assistance may be necessary as the symptoms will only increase over time.

Finally, make sure that you write down your concerns and give them to the doctor before the appointment. The doctor must have information on the symptoms you are seeing, how long you have been seeing them and the frequency in which they are occurring. The doctor has no other way of knowing this information and persons in the early stages of Alzheimer's disease often will be at their best for the short physician examination.

Where Can You Get a Complete Evaluation?

Physicians in family practice, internal medicine, and/or geriatric medicine can complete evaluations for dementia. Neurologists and/or psychiatrists also will frequently make evaluations independently or in conjunction with the primary physician. For more information on where to have an evaluation in your area, call the Alzheimer's Association, National Capital Area Helpline at 703-359-4440 or toll-free 1-800-272-3900.

(Information for this article was drawn from: December 1988 chapter newsletter, "Medical Assessment and Management of Dementia." Norman L. Foster, M.D., 1993. "Getting Medical Help for the Impaired Person" in The 36-Hour Day by Mace and Rabins, 1991. "The Clinical Diagnosis of Alzheimer's Disease: Where Are We Now, Where Are we Headed?" Research and Practice, Fall, 1992. The Alzheimer's Association.)

Credit: Adapted from South Central Michigan Chapter Newsletter, Summer 1993

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703-359-4440 or toll-free 1-800-272-3900