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Diagnosis

GETTING A DIAGNOSIS

Many people work hard to ignore signs of memory loss, preferring not to know if their symptoms reflect Alzheimer's disease or an AD-related dementia. Some may not know that regularly forgetting to pay bills or take medication is not a normal part of getting older. Others may let fear take over: fear of what people will say, of not being in control, or of being ill. Some may rely exclusively on the power of prayer while missing opportunities for healthcare professionals to help.

Getting memory symptoms evaluated by your doctor or other qualified healthcare provider is crucial to helping people live their best quality of life. Many things can cause a decline in memory or thinking ability besides Alzheimer’s disease. Depression, medication effects, sleep disorders, and various medical conditions can all impact memory efficiency, but can often improve when identified and treated. Strokes, injuries to the brain, and infections can also bring on memory loss or thinking problems but can often be managed so as not to continue getting worse.

Even if it turns out to be Alzheimer’s disease or an AD-related dementia, identifying the correct diagnosis early allows opportunities to participate in clinical trials of new medications. It also gives the person with memory loss and their loved ones time to plan for the future and begin making decisions regarding care, family matters, financial planning, and legal issues to ensure that personal wishes and beliefs are known and respected throughout their illness.

DETECTING DEMENTIA

There is currently no single diagnostic test that can determine if a person has Alzheimer's disease or AD-related cause of dementia. Diagnosis requires a detailed history and description of symptoms, review of potential risk factors, and a combination of assessments and laboratory tests, some of which are discussed below.

LABORATORY TESTS

Bloodwork can help rule out health conditions that can cause memory loss, like low levels of vitamin B-12 or underactive thyroid. Some physicians will obtain blood to look for genetic factors associated with risk for Alzheimer’s disease. If infection or fluid build-up in the brain are suspected of causing symptoms, the doctor may also order an evaluation of the fluid that surrounds the spinal cord.

BRAIN IMAGING

Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) show what brain structures look like and can help rule out strokes, tumors, fluid build-up, and injuries to the brain. High resolution MRI can also sometimes detect early loss of brain cells in memory centers caused by Alzheimer’s disease.

Positron Emission Tomography (PET) is a form of brain imaging that can detect the presence and accumulation of abnormal proteins associated with Alzheimer’s disease (amyloid and tau).

NEUROLOGIC EXAMINATION

Neurologists perform specialized examinations to look for physical signs of specific brain diseases. The neurologic exam typically evaluates reflexes, coordination, strength, eye movement, sensory processing, and speech.

COGNITIVE TESTING

When people complain of memory problems it is often helpful to measure the extent and nature of the problem.

Neuropsychologists use specialized tests and procedures to measure memory and other thinking abilities, including naming, visual processing, problem solving, and attention. These tests can seem daunting (especially if you don’t like puzzles) but they can detect some of the earliest changes in memory due to Alzheimer’s disease. Cognitive testing can also help identify when memory loss is not likely due to Alzheimer’s disease.

MOOD EVALUATION

A mental health professional is often consulted if your doctor believes that depression or another mental health condition may be contributing to your symptoms.

WHERE TO START

The first step in ensuring you or your loved one gets the help they need is to know the warning signs commonly associated with Alzheimer’s disease. If you believe these symptoms are present, take note but don’t panic. Remember that many things can cause problems with memory and thinking ability as we age.

If you are concerned about your own memory, make an appointment with your family doctor to discuss your concerns. Your doctor can obtain the appropriate tests and consultations to help understand your symptoms better. If all looks well, your doctor can follow up with you at later visits to see if your memory has changed.

If you are concerned about memory loss in a loved one, a good first step is to see if others have noticed these changes as well. If you remain concerned, the next step is for someone to have a conversation with your loved one. Consider who should have this conversation. It could be you, a trusted family member, or a friend. Although having the conversation can be difficult, try not to put it off. Consider when and where your loved one would feel most comfortable, and try to be open and information-seeking in your approach. For example, you could say: “I’ve noticed your memory sometimes gives you trouble. I’m wondering if you’ve noticed it too?” Explain that many things can affect memory and that a doctor is the best person to figure it out. You can offer to help your loved one make an appointment and to accompany them. Some people respond well to this approach and will appreciate your concern.

Others, however, may be less welcoming of your concerns. They may become defensive or dismissive. The first conversation may not go well, but don’t give up and don’t be afraid to bring it up again, especially if you continue to see problems. Another strategy that some have found helpful is to wait until your loved one goes to the doctor for a different reason and alert the doctor at that time, either by note, phone call, or in person.

LEARN MORE

  • The Memory Disorders Clinic at Mayo Clinic Florida provides comprehensive diagnostic evaluations for people with memory complaints due to possible early Alzheimer’s disease and AD-related disorders.