Diagnosis of Alzheimer's
Tests And Procedure

How Alzheimer's Is Diagnosed

Contents

• How Is Alzheimer's Diagnosed?
• When Doctors Get It Wrong
• What Type Of Doctor Does The Testing?
• The Tests
• Why Diagnose Alzheimer's?
• Are There Genetic Tests For Alzheimer’s?

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Alzheimer's Disease

There is no single test for Alzheimer’s. A team of doctors conduct a battery of physical, neurological and psychiatric tests to rule out other causes of dementia (some of which may be treatable). Only once all other causes have been ruled out, is a diagnosis considered. The diagnosis in reality is a bit of an educated guess. At present the only way to confirm the condition conclusively is to look at the brain during an autopsy.

When Doctors Get It Wrong

In actual practice is it estimated that 25 to 40 percent of people with Alzheimer’s are misdiagnosed. Many may in fact have treatable or reversible conditions that can cause Alzheimer-like symptoms such as thyroid disease, vitamin B deficiency, alcoholism or over-medication. Health professionals believe that only when a detailed examination, as described below, is carried out, can about 90 percent of Alzheimer cases be accurately diagnosed. Unfortunately not all physicians order all the tests, and hence the high rates of misdiagnosis.

What Type Of Doctor Does The Testing?

If your primary care doctor suspects you may have symptoms of Alzheimer's, he will refer you to one or several specialists for a detailed examination. Those specialists include:

Neurologists: Physicians that specialize in diseases of the brain and nervous system.
Psychiatrists: Doctors that specialize in mood disorders and the way the mind works.
Psychologists with special training in testing mental functions and memory.

The Tests

Medical History

A thorough medical history is taken, including a review of current medications and current or past illnesses. The physician will want to know if there is a family history of dementia or Alzheimer's. He will also ask about your diet, nutrition and use of alcohol.

Physical Exam And Diagnostic Tests

Your doctor will:

Check your blood pressure and take your temperature.
Listen to your heart and lungs.
Collect a sample of blood and urine for laboratory testing.

The information from this exam and lab test results can help identify issues that cause Alzheimer-type symptoms. These include diabetes, anemia, kidney disease, liver disease, thyroid problems, vitamin deficiencies and problems of the heart and lungs.

Neurological Exam

A neurologist will closely evaluate the brain to look for signs of diseases, other than Alzheimer's, that could be responsible for problems. This includes brain tumors, mini-strokes, large strokes, fluid accumulation and Parkinson’s' disease. He will test your reflexes, speech, eye movement, coordination, muscle strength and tone. He may also order images to be taken of the brain with either an MRI scan or CT scan.

Psychiatric Assessment

A geriatric psychiatrist is a medical doctor who specializes in diagnosing and treating mental disorders in older people. While Alzheimer's is not a mental illness, it causes symptoms similar to mental illnesses such as agitation, depression, hallucinations and anxiety. If someone is having these experiences, it may help to have a psychiatric evaluation. The doctor will assess the person's:

• Mood stability
• How they look and behave
• How they process thoughts, their awareness of time and place
• Memory and thinking skills
• Body posture, eye contact and communication skills
• Physical symptoms, sleep and appetite
• Decision making ability
• Social skills (ability to relate to others)

He will also go through a questionaire and rate the patient's abilities. After the appointment, he should be able to give a preliminary opinion.

Why Diagnose Alzheimer's?

Given there is no cure for the disease, and treatment at best only slows symptoms for 12 months, you may wonder, why go to all this trouble to diagnose Alzheimer's? There are several reasons:

1. It may not be Alzheimer's, the patient may have another disorder which is treatable.
2. If they do have Alzheimer's it allows them time to plan for the future. To make decisions about care, living options, finances and legal matters.
3. The person can opt to participate in clinical drug trials, which may benefit them.

Are There Genetic Tests For Alzheimer’s?

Yes, although health professionals do not currently recommend using genetic tests. Scientists have discovered certain genes associated with Alzheimer’s (see causes of Alzheimer’s). Risk genes, are genes that raise your risk of developing the disease, but do not guarantee it. While there is a blood test for APOE-e4 (the strongest risk gene associated with Alzheimer’s), even if you test positive it does not mean you have the disease nor that you will develop it. Furthermore, people without risk genes can still develop the disease. A 'clean' test may provide false reassurance.

In rare cases, people inherit deterministic genes, which directly cause autosomal dominant Alzheimer's disease (ADAD) or early onset Alzheimer’s. If you have these genes, you will develop ADAD. Many people in families with a history of ADAD do not wish to know their fate and refuse testing, but some do take the test.

Next: Treatment for Alzheimer's.

For more information, see the following:

• Stages of Alzheimer's: Stages 1 to 7.
• Alternative treatment for alzheimer's: Dietary tips and therapies.
• How to prevent Alzheimer's: Can you prevent it?

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