The diagnostic process begins with your family doctor. After your initial assessment, he may make the diagnosis himself, recommend additional testing, or refer you to a specialist. After a diagnosis is made, you will likely continue to see your family doctor for ongoing assessment.
During your initial assessment, your family doctor will ask you questions about your symptoms, past illnesses, and family medical and psychiatric history. You may also undergo physical examinations and tests, which may include detailed blood work to look for heart, lung, liver, kidney or thyroid problems that may be causing your symptoms. To evaluate whether another nervous system disorder may be causing the symptoms, your doctor may also test muscle tone and strength, coordination, eye movement, speech and sensation.
Your doctor may also conduct mental tests to 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?” After an initial assessment, your doctor may feel able to make a diagnosis, or may refer you to a memory clinic or other specialist service for more testing.
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) to take images of the brain.
- SPECT (single proton emission computed tomography) showing how blood is circulating to the brain.
- PET (positive electron tomography) showing how the different areas of the brain respond during certain activities, for example, reading and talking.
Referral to a specialist
If you feel that a referral would be helpful and your family doctor does not suggest it, you can request it. Your doctor may refer you to one of the following specialists:
- Neurologist, who specializes in disorders of the brain and nerve pathways. Some neurologists have particular experience in diagnosing dementia.
- Geriatrician, who specializes in the physical illnesses and disabilities associated with old age and in the care of older people.
- Psychiatrist, who 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 Alzheimer's disease. Neuropsychological testing can evaluate your memory, reasoning, and writing abilities. Geriatric psychiatrists are psychiatrists who have further specialized in the mental health problems of older people, including dementia.
Once a diagnosis is confirmed, make an appointment to see your family doctor from time to time to assess changes and discuss any problems. Your doctor may refer you to a specialist for help in assessing changes, and for advice on ways to deal with specific difficulties. Your family doctor is also responsible for your general health when you have dementia.