- Medical history -- This should include questions about past illnesses, prior injuries and surgeries, and current chronic conditions in order to identify other possible causes for Alzheimer's-like symptoms. For instance, if you suffered a serious head injury any time in your past, it could account for the problems with memory or concentration that you're currently experiencing. If your loved one has heart disease, that could be reducing blood flow to the brain and causing forgetfulness.
- Medication history -- This should include allergies, experienced side effects from past medications, and a list of current medications and dosages. Not only will this inform any future prescription decisions; it also might reveal a medication interaction or overdosage that accounts for your or your loved one's confusion and other symptoms.
- Mood evaluation -- The evaluation should include an assessment for anxiety or depression, which can create Alzheimer's-like symptoms in older people as well as occur concurrently with Alzheimer's or another dementia. Depression, in particular, can result in a set of symptoms collectively known as pseudodementia. If a mood disorder is detected, it can be treated alongside other disorders, such as Alzheimer's.
- Mental status exam -- To assess memory, concentration, and other cognitive skills. The mental status exam is a research-based set of questions that results in a score that indicates a general level of impairment. If you or your loved one scores high on a mental status exam, there is less of a chance that Alzheimer's is the culprit; another (possibly treatable) condition may be responsible for the symptoms. However, highly educated individuals have scored high on mental status exams even though they do have Alzheimer's disease.
- Complete physical exam -- To assess hearing, vision, blood pressure, pulse, and other basic indicators of health and disease. A current physical exam can detect acute medical conditions such as an infection that might be causing Alzheimer's-like symptoms.
- Appropriate laboratory tests -- These will vary according to your or your loved one's medical history and current symptoms. Blood tests are the most common laboratory tests ordered. For example, if you are exhibiting pre-diabetic symptoms, a blood glucose test would be ordered. Aside from blood tests, if your loved one's symptoms came on suddenly and include severe confusion, a urinalysis would probably be conducted to rule out a urinary tract infection.
- Neurological exam -- This should include an examination of the motor system (movement), reflexes, gait (walking), sensory functioning, and coordination in order to detect problems with the nervous system that may be causing problems with thinking and behavior.
- Imaging procedures -- Detailed pictures of the brain, such as a CT scan (computed tomography), an MRI (magnetic resonance imaging), or a PET scan (positron emission tomography) to identify changes in brain structure or size indicative of Alzheimer's, or to look for brain tumors, blood clots, strokes, normal pressure hydrocephalus (NPH), or other abnormalities that might account for Alzheimer's-like symptoms.
There is no particular kind of physician that specializes in Alzheimer’s disease. Many people first seek help from their primary care physician, who may oversee the total diagnostic process or refer the individual to any of the following specialists:
- Neurologist -- Specializes in diseases of the nervous system, including Alzheimer’s, Parkinson’s, epilepsy, and stroke.
- Psychiatrist -- Specializes in mental, emotional, and behavioral disorders.
- Neuropsychologist -- Specializes in the brain-behavior relationship and can conduct neuropsychological testing to determine the type and level of impairment due to Alzheimer's, head injury, stroke, or other conditions.
The goal of a diagnostic workup is to explore every possible cause for the person's symptoms and to address any reversible condition or treatable problem. If a cause is not reversible or treatable, then the goal is to help the individual manage the symptoms through medical treatments or behavior management.
Sources:
Alzheimer's diagnosis. Fisher Center for Alzheimer's Research Foundation. 2007. http://www.alzinfo.org/alzheimers-diagnosis.asp
Basics of Alzheimer’s disease: What it is and what you can do. Alzheimer's Association. 2005. http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf
