Clinical Assessment for Alzheimer's

What Doctors Look at in a Clinical Assessment for Alzheimer's
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Alzheimer's disease can't be diagnosed with one test. Instead, doctors rely on a detailed medical workup known as a clinical assessment to diagnose Alzheimer's and other causes of dementia. That's why seeing a doctor is one of the first things you should do if you suspect Alzheimer's in a loved one. A clinical assessment involves many different tests.

"People are often afraid to see their doctor because they think there's only one outcome, but there are reversible causes of cognitive decline, so it's important to start with a primary care doctor when you're concerned," says Paul J. Mattis, chief of adult neuropsychology at Northshore University Hospital in Manhasset, New York.

The doctor's three goals in a clinical assessment for dementia are to document evidence of cognitive impairment, rule out other common causes for impaired thinking, and determine if other changes noted are consistent with Alzheimer's or another cause of dementia.

An experienced clinician can make an accurate Alzheimer's disease diagnosis from a clinical assessment up to 90 to 95 percent of the time, says neuroscientist and physician Paul Aisen, director of the Alzheimer's Disease Cooperative Study, a consortium of 80 academic institutions conducting Alzheimer's clinical trials. "Less experienced doctors accurately diagnose Alzheimer's 80 to 95 percent of the time," he adds.

What happens at a clinical assessment in the clinic

When a physician sees a patient concerned about memory problems or other symptoms of dementia, he or she will usually gather the following information or arrange for these tests:

  • A history of the present illness. The doctor will ask questions about memory problems or other concerning symptoms and will ask about other signs and symptoms that may be related to dementia or delirium, a temporary condition that's often mistaken for dementia. The doctor will also ask questions that help screen for depression, anxiety, or other psychiatric issues.

  • A review of past medical history. The doctor will review past illnesses and treatments and may ask about family history. He or she will ask about medications being taken and may inquire as to the patient's health habits, including diet and exercise, and work and social status (such as whom the person lives with).

  • A physical exam. This includes taking vital signs (blood pressure, pulse, temperature, weight), listening to heart and lungs, looking for signs of neurological impairment, and making a visual inspection.

  • Lab work. Lab tests usually include a complete blood count, urine tests, liver function tests, glucose count, and other tests to look for clues to underlying problems, such as infection or thyroid imbalance.

  • A brief cognitive screening test. These short (5- to 15-minute) tests involve asking a series of questions, which are scored, to look for signs of problems with thinking skills. Memory, verbal ability, problem-solving ability, ability to follow directions, and other areas that make up cognition are evaluated. Scoring poorly on a cognitive-status test doesn't mean the subject has Alzheimer's, only that there are cognitive deficits going on for some reason.

Other parts of a clinical assessment

In addition, the doctor may refer the patient being seen for dementia symptoms to the following kinds of exams, some of which are administered by specialists:

  • A neuropsychological evaluation. A neurologist, psychologist, or psychiatrist can conduct more in-depth testing on which specific thinking skills are weak. He or she can also test physical coordination, reflexes, balance, and speech.

  • A brain scan. An MRI, CT scan, or PET scan may be ordered to look for evidence of tumor, trauma, or strokes that are causing impairment.

  • Other tests. Depending on what the doctor sees or suspects, additional testing may include chest X-ray, spinal tap, EEG (to evaluate brain activity), and -- in the rare cases of a family history of early-onset Alzheimer's (before age 60) -- genetic testing.

What else to know about a clinical assessment for dementia symptoms

  • Clinical assessments are often completed over the course of several office visits, because the 15 to 20 minutes of the typical primary care exam aren't enough. Specialty clinics, such as memory clinics, may offer longer appointments for a more complete assessment in one visit.

  • Ideally, someone who lives with the person having symptoms should be part of the exam. A family member is likely to recall history more accurately and present a more accurate picture of symptoms. Many doctors go so far as to call a family member the critical "third leg of the stool" in dementia assessment: patient, doctor, and caregiver.

  • If you're wary of insulting a loved one by speaking up during a checkup, or you feel otherwise unable to speak up about your concerns, express your worries to the doctor in writing, before the exam. Briefly list your observations, if possible with specific examples about what's been happening and when worrisome behaviors started.

  • Bring to the checkup all medications currently taken or recently completed. A list of drugs is good, but the actual containers are better. Include over-the-counter medications and supplements taken regularly.

Find out why some doctors seem slow to diagnose Alzheimer's.

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

almost 3 years, said...

I seem to have all the common symptoms of Alzheimer disease.My psychiatrist won't test me because he said it is a physical problem, thus not a psych problem. I am confused. The symptoms seem to be psych in nature.

almost 4 years, said...

We also gave my mother-in-law options of moving in with us & our daughter & her 2 kids (who live with us now), & having them move into her house (a win-win-win situation), but she refuses to have them live in her house. Actually, the house is in my husband's name. Or to have another 30 year old daughter, who lives with us, moving in with her. She doesn't want that either. She is being very difficult. We all are trying to do our best to take care of her the best we can. She just wants to go home and "I will be just fine." No, Not really. Especially if her organs are giving out on her.

almost 4 years, said...

My husband & I are dealing with his mother's health conditions--kind of "end of life" issues. She is in the hospital right now. She has been steadily declining the past 5 years, but seriously, this past month or so. Her heart is bad & has COPD, liver deteriorating, and now her kidneys are failing. She had a regular Doctor appointment Fri. and he took a blood test. We got back home, I got her settled in & started making her some soup when they called me back & said to get her right back in she had less kidney function etc. and was very dehydrated (some from Furosemide she had been taking for water retention). She was sent to the ER for IV fluids & the ER Dr. admitted her to the hospital for monitoring & to have more IV fluids. Her regular Dr. doesn't want her to live alone. Being totally stubborn & bullheaded, she refuses to leave her house or go into Assisted Living or a Nursing Home. My husband & I have been at her house almost every ay as it is. I have pretty much been her caregiver & done almost everything to help her. The Dr. mentioned Hospice even, so we are thinking there must not be a lot of time left. We feel like we are in over our heads, especially with caring for her. How do we get other in-home care help? We can't afford to hire anyone. Are there other services available to us? Through the State?

almost 6 years, said...

I have a few memory issues and I suspect this disease will rear its ugly head sooner the later. Both my mother and grandmothers have suffered from this disease. I actually retired last year because of memory issues at work.

over 6 years, said...

A good listing of the tests used, so we will know what to ask for.