How Is Dementia Diagnosed?

Doctors employ a number of strategies to diagnose dementia. t is

important that they rule out any treatable conditions, such as depression,
normal pressure hydrocephalus, or vitamin B12 deficiency, which can
cause similar symptoms.
Early, accurate diagnosis of dementia is important for patients and their
families because it allows early treatment of symptoms. For people with AD
or other progressive dementias, early diagnosis may allow them to plan for
the future while they can still help to make decisions. These people also
may benefit from drug treatment.
The "gold standard" for diagnosing dementia, autopsy, does not help the
patient or caregivers. Therefore, doctors have devised a number of
techniques to help identify dementia with reasonable accuracy while the
patient is still alive.
Patient history
Doctors often begin their examination of a patient suspected of having
dementia by asking questions about the patient's history. For example, they
may ask how and when symptoms developed and about the patient's
overall medical condition. They also may try to evaluate the patient's
emotional state, although patients with dementia often may be unaware of
or in denial about how their disease is affecting them. Family members also
may deny the existence of the disease because they do not want to accept
the diagnosis and because, at least in the beginning, AD and other forms of
dementia can resemble normal aging. Therefore additional steps are
necessary to confirm or rule out a diagnosis of dementia.
PhysicaI examination
A physical examination can help rule out treatable causes of dementia and
identify signs of stroke or other disorders that can contribute to dementia. t
can also identify signs of other illnesses, such as heart disease or kidney
failure, that can overlap with dementia. f a patient is taking medications
that may be causing or contributing to his or her symptoms, the doctor may
suggest stopping or replacing some medications to see if the symptoms go
away.
euroIogicaI evaIuations
Doctors will perform a neurological examination, looking at balance,
sensory function, reflexes, and other functions, to identify signs of
conditions - for example movement disorders or stroke - that may affect the
patient's diagnosis or are treatable with drugs.
Cognitive and neuropsychoIogicaI tests
Doctors use tests that measure memory, language skills, math skills, and
other abilities related to mental functioning to help them diagnose a
patient's condition accurately. For example, people with AD often show
changes in so-called executive functions (such as problem-solving),
memory, and the ability to perform once-automatic tasks.
Doctors often use a test called the Mini-Mental State Examination (MMSE)
to assess cognitive skills in people with suspected dementia. This test
examines orientation, memory, and attention, as well as the ability to name
objects, follow verbal and written commands, write a sentence
spontaneously, and copy a complex shape. Doctors also use a variety of
other tests and rating scales to identify specific types of cognitive problems
and abilities.
Brain scans
Doctors may use brain scans to identify strokes, tumors, or other problems
that can cause dementia. Also, cortical atrophy -degeneration of the brain's
cortex (outer layer) - is common in many forms of dementia and may be
visible on a brain scan. The brain's cortex normally appears very wrinkled,
with ridges of tissue (called gyri) separated by "valleys" called sulci. n
individuals with cortical atrophy, the progressive loss of neurons causes the
ridges to become thinner and the sulci to grow wider. As brain cells die, the
ventricles (or fluid-filled cavities in the middle of the brain) expand to fill the
available space, becoming much larger than normal. Brain scans also can
identify changes in the brain's structure and function that suggest AD.
The most common types of brain scans are computed tomographic (CT)
scans and magnetic resonance imaging (MR). Doctors frequently request
aCT scan of the brain when they are examining a patient with suspected
dementia. These scans, which use X-rays to detect brain structures, can
show evidence of brain atrophy, strokes and transient ischemic
attacks (TAs), changes to the blood vessels, and other problems such as
hydrocephalus and subdural hematomas. MR scans use magnetic fields
and focused radio waves to detect hydrogen atoms in tissues within the
body. They can detect the same problems as CT scans but they are better
for identifying certain conditions, such as brain atrophy and damage from
small TAs.
Doctors also may use electroencephalograms (EEGs) in people with
suspected dementia. n an EEG, electrodes are placed on the scalp over
several parts of the brain in order to detect and record patterns of electrical
activity and check for abnormalities. This electrical activity can indicate
cognitive dysfunction in part or all of the brain. Many patients with
moderately severe to severe AD have abnormal EEGs. An EEG may also
be used to detect seizures, which occur in about 10 percent of AD patients
as well as in many other disorders. EEGs also can help diagnose CJD.
Several other types of brain scans allow researchers to watch the brain as
it functions. These scans, called functional brain imaging, are not often
used as diagnostic tools, but they are important in research and they may
ultimately help identify people with dementia earlier than is currently
possible. Functional brain scans include functional MR (fMR), single
photon-emission computed tomography (SPECT), positron emission
tomography (PET), and magnetoencephalography (MEG). fMR uses radio
waves and a strong magnetic field to measure the metabolic changes that
take place in active parts of the brain. SPECT shows the distribution of
blood in the brain, which generally increases with brain activity. PET scans
can detect changes inglucose metabolism, oxygen metabolism, and blood
flow, all of which can reveal abnormalities of brain function. MEG shows the
electromagnetic fields produced by the brain's neuronal activity.
aboratory tests
Doctors may use a variety of laboratory tests to help diagnose dementia
and/or rule out other conditions, such as kidney failure, that can contribute
to symptoms. A partial list of these tests includes a complete blood
count, blood glucose test, urinalysis, drug and alcohol tests (toxicology
screen), cerebrospinal fluid analysis (to rule out specific infections that can
affect the brain), and analysis of thyroid and thyroid-stimulating hormone
levels. A doctor will order only the tests that he or she feels are necessary
and/or likely to improve the accuracy of a diagnosis.
Psychiatric evaIuation
A psychiatric evaluation may be obtained to determine if depression or
another psychiatric disorder may be causing or contributing to a person's
symptoms.
Presymptomatic testing
Testing people before symptoms begin to determine if they will develop
dementia is not possible in most cases. However, in disorders such as
Huntington's where a known gene defect is clearly linked to the risk of the
disease, a genetic test can help identify people who are likely to develop
the disease. Since this type of genetic information can be devastating,
people should carefully consider whether they want to undergo such
testing.
Researchers are examining whether a series of simple cognitive tests, such
as matching words with pictures, can predict who will develop dementia.
One study suggested that a combination of a verbal learning test and an
odor-identification test can help identify AD before symptoms become
obvious. Other studies are looking at whether memory tests and brain
scans can be useful indicators of future dementia.

Dementia is a set of signs and symptoms

Dementia is a non-specific syndrome in which affected areas of brain
function may be affected, such as memory, language, problem solving and
attention. Dementia, unlike Alzheimer's, is not a disease in itself. When
dementia appears the higher mental functions of the patient are involved
initially. Eventually, in the later stages, the person may not know what day
of the week, month or year it is, he may not know where he is, and might
not be able to identify the people around him.

Dementia is significantly more common among elderly people. However, it
can affect adults of any age.
hat are the symptoms of dementia?
O emory Ioss - the patient may forget his way back home from the
shops. He may forget names and places. He may find it hard to
remember what happened earlier on during the day.

O oodiness - the patient may become more and more moody as parts of
the brain that control emotion become damaged. Moods may also be
affected by fear and anxiety - the patient is frightened about what is
happening to him.

O Communicative difficuIties - the affected person finds it harder to talk
read and/or write.
As the dementia progresses, the patient's ability to carry out everyday
tasks diminishes and he may not be able to look after himself.

Dementia - Symptoms
Symptoms of dementia vary depending on the cause and the area of the brain
that is affected. Memory loss is usually the earliest and most noticeable
symptom. Other key symptoms of dementia include:
O Having difficulty recalling recent events.
O Not recognizing familiar people and places.
O Having trouble finding the right words to express thoughts or name objects.
O Having difficulty performing calculations.
O Having problems planning and carrying out tasks, such as balancing a
checkbook, following a recipe, or writing a letter.
O Having trouble exercising judgment, such as knowing what to do in an emergency.
O Having difficulty controlling moods or behaviors. Depression is common, and
agitation or aggression may occur.
O Not keeping up personal care such as grooming or bathing.
Some types of dementia cause key symptoms:
O People who have dementia with Lewy bodies often have highly detailed visual
hallucinations. They may fall frequently.
O The first symptoms of frontotemporal dementia may be personality changes or
unusual behavior. People with this condition may not express any caring for
others, or they may say rude things, expose themselves, or make sexually
explicit comments.
Symptoms of dementia that come on suddenly suggest vascular dementia or
possibly delirium-short-term confusion caused by a new or worsening illness.

Dementia Symptoms
Symptoms of dementia vary considerably by the individual and the underlying
cause of the dementia. Most people affected by dementia have some (but not all)
of these symptoms. The symptoms may be very obvious, or they may be very
subtle and go unrecognized for some time. The first sign of dementia is usually
loss of short-term memory. The person repeats what he just said or forgets
where she put an object just a few minutes ago. Other symptoms and signs are
as follows:
arIy dementia
O Word-finding difficulty - May be able to compensate by using synonyms or
defining the word
O Forgetting names, appointments, or whether or not the person has done
something; losing things
O Difficulty performing familiar tasks - Driving, cooking a meal, household
chores, managing personal finances
O Personality changes (for example, sociable person becomes withdrawn or a
quiet person is coarse and silly)
O Uncharacteristic behavior
O Mood swings, often with brief periods of anger or rage
O Poor judgment
O Behavior disorders - Paranoia and suspiciousness
O Decline in level of functioning but able to follow established routines at home
O Confusion, disorientation in unfamiliar surroundings - May wander, trying to
return to familiar surroundings
Intermediate dementia

O Worsening of symptoms seen in early dementia, with less ability to

compensate
O Unable to carry out activities of daily living (eg, bathing, dressing, grooming,
feeding, using the toilet) without help
O Disrupted sleep (often napping in the daytime, up at night)
O Unable to learn new information
O ncreasing disorientation and confusion even in familiar surroundings
O Greater risk of falls and accidents due to poor judgment and confusion
O Behavior disorders - Paranoid delusions, aggressiveness, agitation,
inappropriate sexual behavior
O Hallucinations
O Confabulation (believing the person has done or experienced things that
never happened)
O nattention, poor concentration, loss of interest in the outside world
O Abnormal moods (anxiety, depression)
Severe dementia

O Worsening of symptoms seen in early and intermediate dementia

O Complete dependence on others for activities of daily living
O May be unable to walk or move from place to place unassisted
O mpairment of other movements such as swallowing - ncreases risk
ofmalnutrition, choking, and aspiration (inhaling foods and beverages, saliva,
ormucus into lungs)
O Complete loss of short- and long-term memory - May be unable to recognize
even close relatives and friends
O Complications - Dehydration, malnutrition, problems with bladder control,
infections, aspiration, seizures, pressure sores, injuries from accidents or falls
The person may not be aware of these problems, especially the behavior
problems. This is especially true in the later stages of dementia.
Depression in elderly people can cause dementialike symptoms. As many as
40% of people with dementia are also depressed. Common symptoms of
depression include depressed mood, loss of interest in activities once enjoyed,
withdrawal from others, sleep disturbances, weight gain or
loss, suicidal thoughts, feelings of worthlessness, and loss of ability to think
clearly or concentrate.
People with irreversible or untreated dementia present a slow, gradual decline in
mental functions and movements over several years. Total dependence and
death, often from infection, are the last stages.