What to expect while getting your diagnosis

The initial assessment

The initial assessment is the first step your family doctor will take to determine whether or not you have dementia.

No single test can tell if a person has dementia. The diagnosis is made through an assessment that eliminates other possible causes. Until there is a conclusive test, doctors may continue to use the words “probable Alzheimer’s disease” or "probable dementia". A family doctor or a specialist can make the diagnosis, and it may take time. The doctor may or may not refer you to other health-care professionals.  

During the initial assessment, your doctor will ask you questions about your medical history and have you take some physical and mental status exams.

Questions about your medical history

You and your caregiver will be asked questions about your symptoms now and in the past. There will be questions about past illnesses, family medical and psychiatric history and your current health and lifestyle. These questions may sound like:

• What are your symptoms like? Can you describe them?
• When did you start noticing these symptoms?
• What's your family medical and psychiatric history?

Get some tips on how to talk to your doctor about dementia.

Mental status exam

Your doctor may also conduct mental status exams or cognitive assessments. These tests measure your sense of time and place, as well as your ability to remember, express yourself, and perform simple calculations. This may involve exercises such as recalling words and objects, drawing and spelling, and questions such as "What year is it?”

An example of a mental status exam is the Montreal Cognitive Assessment (MoCA), a test that measures judgement, planning, problem-solving, reasoning and memory.

Physical exams

To help rule out other causes, your doctor may conduct a physical exam:

• The exam will focus on the brain and nervous system. Other body systems that can affect brain function, such as blood pressure, and heart and lung function, will also be examined.
• The doctor will also test muscle tone and strength, coordination, eye movement, speech and sensation.

Additional exams

After an initial assessment, your doctor may feel like they have the information they need to make a conclusive diagnosis. If not, they may recommend you for more exams that involve laboratory work. Laboratory tests take more time, but they will help ensure that your diagnosis is accurate.

Blood tests

• Your doctor may have you undergo detailed blood work.
• These tests will help detect problems such as anemia, diabetes and thyroid problems that might be adding to symptoms.

Brain imaging tests

A number of brain imaging tests may also be required to see if there is evidence of a recent stroke or changes to your brain’s blood vessels, such as bleeding.

In some medical centres, scans may be used. The following brain imaging tests may be recommended, but are not always necessary for a diagnosis:

• Computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan. These take images of your brain, showing its structure. Through CT and MRI scans, doctors can also tell if there is any shrinkage of the brain happening.
• Single proton emission computed tomography (SPECT) scan. This shows how blood is circulating through your brain.
• Positive electron tomography (PET) scan. This shows how the different areas of your brain respond during certain activities such as reading and talking. This scan is usually done after 45 minutes of rest.

Sleep tests

• Sleep tests measure brain activity to determine levels of cognitive performance and brain aging.

Referral to a specialist

Your doctor may also recommend you go to a memory clinic or other specialist service for more testing. If you feel that a referral would be helpful and your doctor does not suggest it, you can request it.

A qualified specialist could be a psychologist, psychiatrist, neurologist, geriatrician, nurse, social worker or occupational therapist. They will look for problems with your memory, reasoning ability, language and judgment, and how these affect day-to-day function.

Here are some of the specialists you may be referred to:

Neurologist

A neurologist specializes in disorders of the brain and nerve pathways. Some neurologists have particular experience in diagnosing dementia.

Geriatrician

A geriatrician specializes in physical illnesses and disabilities associated with old age and in the care of older adults.

Psychiatrist

A psychiatrist specializes 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 dementia.

These specialists can also cross over into each other's areas:

• Neuropsychological testing can evaluate your memory, reasoning, and writing abilities.
• Geriatric psychiatrists are psychiatrists who have further specialized in the mental health of older adults, including dementia.

Ongoing assessment

After the exams are complete, you will likely continue to see your family doctor for ongoing assessment.

If you get a diagnosis of dementia, make an appointment to see your family doctor from time to time to assess changes and discuss any problems.

Your doctor can still help you in many ways. They can:

• Refer you to a specialist for help in assessing changes,
• Give you advice on ways to deal with specific changes you experience and
• Through referral services like First Link®, connect you to your local Alzheimer Society and programs and services in your community. These programs and services can provide you with dementia education, resources and support that can help you maintain your quality of life.

Your family doctor is also responsible for your general health when you have dementia.

Learn about the first steps to take after being diagnosed with dementia.

Key points to know

• There is no single, specific test that can diagnose dementia.
• Diagnosis of dementia is made through a systematic assessment, involving your medical history and a number of tests, that eliminates other possible causes.
• Because there can be a lot involved in the process of diagnosis, including laboratory tests and referrals to specialists, getting an official, conclusive diagnosis can take some time.
• Only your doctor or a qualified specialist, such as a neurologist or a psychologist, can give you an official diagnosis.
• Online self-assessments that claim they can effectively diagnose you can be inaccurate, misleading and put you at risk.
• Until the official, conclusive diagnosis is reached, doctors may continue to use the words “probable Alzheimer’s disease” or "probable dementia". But until then, don't assume that you certainly have (or don't have) dementia.
• If you are diagnosed with dementia, keep meeting with your doctor to note changes in your abilities and assess problems you may face. There are recommended first steps to take after diagnosis that you can follow.

More useful links and resources

Getting a diagnosis. Alzheimer Society of Canada. This downloadable brochure summarizes what you need to know about getting a diagnosis, including how to prepare for your assessment and what to expect during the diagnostic process.

Getting a diagnosis toolkit. Alzheimer Society of Canada. Use this toolkit to help you prepare for a conversation with your doctor or healthcare provider about your concerns and questions about a possible dementia diagnosis.

Evaluating memory and thinking problems: What to expect. Alzheimer's Association. This interactive webpage is a fun, visual way to understand what to expect while getting your diagnosis. The information on this page is also included in a downloadable, print-friendly PDF.