Assessments

If you or someone you care about is showing signs such as forgetfulness, confusion or agitation, speak to your family doctor. (If you don’t have a family doctor, you can call your local Alzheimer Society). At the end of the assessment, the family doctor may feel able to make a diagnosis, or she may request further test to make sure. She may also want to refer the person to a memory clinic or other specialist service for a fuller assessment.

Tests

The following tests and assessments are often conducted to determine a diagnosis:

Analysis of background information − Your family doctor will ask you questions about the symptoms now and in the past. There will be questions about past illnesses and about family medical and psychiatric history.

Physical examinations and tests − To help rule out other causes, the doctor will do a physical exam,  including detailed blood work, looking for heart, lung, liver, kidney or thyroid problems that may be causing the symptoms. To evaluate whether another nervous system disorder may be causing the symptoms, the doctor will test muscle tone and strength, coordination, eye movement, speech and sensation.

Mental tests − This part of the process tests the person's sense of time and place as well as the ability to remember, express himself and do simple calculations. It may involve exercises such as recalling words and objects, drawing and spelling, and questions such as "What year is it?”

Scans

Other tests such as X-rays and EEGs (electroencephalograms) may be used to determine the source of the problem. In some centres, scans may be used. The following may be recommended, but are not always necessary for a diagnosis:

• CT (computerized tomography) scan and MRI (magnetic resonance imaging) take images of the brain.
• SPECT (single proton emission computed tomography) shows how blood is circulating to the brain.
• PET (positive electron tomography) shows how the different areas of the brain respond during certain activities, for example, reading and talking.

Referral to a specialist

Your family doctor may refer you to a specialist.  If you feel that a referral would be helpful and the family doctor does not suggest it, you can request a referral. You may want to ask for a referral to a memory clinic or other specialist service for a second opinion or for support, and access to services that such a referral may give.

The main types of specialists are:

• Neurologists specialize in disorders of the brain and nerve pathways. Some neurologists have particular experience in diagnosing dementia.
• Geriatricians specialize in the physical illnesses and disabilities associated with old age and in the care of older people.
• Psychiatrists specialize in diagnosing and treating a wide range of mental health problems. A psychiatric evaluation may be helpful in ruling out other illnesses such as depression, which can cause symptoms similar to those associated with Alzheimer's disease. Neuropsychological testing can evaluate memory, reasoning, writing, etc. Geriatric psychiatrists are psychiatrists who have further specialized in the mental health problems of older people, including dementia.

Ongoing assessment

Once the diagnosis is confirmed, the family doctor should arrange to see the person with dementia from time to time to assess changes and discuss any problems. She may refer the person with dementia to a specialist for help in assessing changes, and for advice on ways to deal with specific difficulties. The family doctor is also responsible for the general health of the person with dementia.

If you or someone you are close to is diagnosed with dementia, don't be afraid to seek help from your family doctor, or from local support groups, if you feel you need it.