How is it diagnosed?
The first step in establishing a diagnosis is to have a formal memory assessment. This will begin with a full thorough history and physical examination by your neurologist. Both you and your significant other or carer will be interviewed together and separately. The purpose of this is to get the best assessment of memory and day-to-day functioning and often spouses or carers will be mindful of upsetting their loved one so find it easier to chat alone. Similarly, people with memory problems or stress at the thought of having memory problems perform better on the tests when alone with the doctor. The questions you are asked will help your neurologist firstly decide if there is in fact any memory issue. Once that is established the type of memory issue will be investigated. This has important implications in regards to what to expect going forward.
Another important component of the history is to establish if there is any other condition that is not dementia but could present with memory problems. For example, stress, anxiety and depression can commonly lead someone to believe their memory is declining. Therefore identifying this through the history could lead to treatment of depression and an improvement in memory. Often medications can lead to memory problems as a potential side effect. In this scenario reducing or stopping this medication may have a positive impact upon memory. Again if there are medications potentially affecting your memory this will be highlighted in the history.
The purpose of the physical examination is to make sure there is no other condition that could be present and contributing to the memory issue. For example, if you had a previous stroke there would be signs of this on the examination and this may lead your neurologist to consider a vascular type of dementia. Or if you have any signs of Parkinson’s disease this will lead to further tests and then treatment of this disease.
The next part in establishing the diagnosis is likely to be a series of blood tests. Again, these are mainly to rule out potential illnesses that can make memory function worse. For example, if you have an underactive thyroid then you may suffer from extreme lethargy and just not feeling yourself and this may become apparent as problems with overall cognitive functioning. However, treating the underactive thyroid should lead to a substantial improvement in your symptoms. Other routine blood tests will also be done such as your renal and liver function, full blood count and vitamin B12 levels.
You will then go on to have a brain scan. Ideally this will be an MRI of your brain. This will give an idea of whether or not you have atrophy (or thinning) of certain brain areas that are particularly involved in memory and other cognitive functioning. The pattern of abnormalities on your brain scan will give your neurologist further information as to what form of dementia you may be suffering from. Also it is a good way to evaluate whether or not you have had small strokes over time which may indicate the vascular form of dementia. There are other brain scans that can be done but they are reserved for more specialised settings and are not available in most hospitals.
Once all of the tests have been completed you will then meet again with your neurologist to discuss the results of the tests and the diagnosis. If you are then going to undergo a treatment plan this will be tailored to suit your needs and the need for follow up memory testing and brain scans will be discussed also.