When worried about a positive diagnosis of Alzheimer’s, it is important to seek medical examination as soon as possible. Early symptoms such as memory disturbance and confusion can be caused by other conditions, some of which are easily treated while others may be life threatening.

The first step is identifying the symptoms.  Relatives and carers will be the first to notice memory loss and confusion.  In the early stages, patients themselves will probably be aware of problems and may succesfully cover them up.  

Speed of onset of symptoms may indicate a cause other than Alzheimers disease.

To rule out other conditions, the doctor will check the patients general health and any medication they are currently taking.  Assuming their health is otherwise good and contraindications are not suspected, more tailored investigations will then be organised. 

Alzheimers remains a concern if the patient gradually started exhibiting the early signs of memory disturbance, confusion and a general change in personality.   At this point, the investigation would become more specific to assess the extent of the problems, and how likely they are to be caused by dementia.

Questions regarding the persons general behaviour and attitude will be asked.  The doctor will also want to know whether they are unusually anxious or depressed, and whether there has been any specific event that may have triggered it.  This rules out problems that could cause a change in personality.

Communication difficulties, such as ability to remember words, decision-making and judgment will all be assessed.  Changes to daily self-management such as cleaning, grooming, and altered patterns of behaviour could be indicative of its onset.

Once it is established that dementia is present, a series of diagnostic tests would usually be performed to exclude other causes, such as vascular disease.  Conditions involving the heart and / or lung disorders are of primary concern as they are both likely to cause impaired oxygen supply to the brain, thus leading to dementia-like symptoms.

Laboratory tests

These are normally used to eliminate other possible causes.

Mental Status Examination

Usually performed by a neurologist or GP, this is a way of determining the degree of dementia by evaluating the patients cognitive abilities.  This is done by assessing the patients orientation to time and place, long- and short-term memory, mathematical skills, abstract reasoning and judgment, reading, writing and symbolic drawing.

Neurological Examination

Once dementia has been clarified, neurological examinations may be used to distinguish the cause.

An EEG, or electroencephalogram, can be used to measure electrical activity in the brain.  Abnormally slow activity is indicative of Alzheimers, although some patients show normal brain activity so this test does not rule it out as a possible cause.  The characteristic shrinkage of the brain seen can sometimes be viewed via a CAT (computerised axial tomogram) scan or MRI (magnetic resonance imaging) scan, but while these tests are sufficient to confirm or eliminate other causes of dementia, they are not conclusive of the disease itself.

New, more costly tests may assist in the diagnosis of Alzheimers, such as PET (positron emission tomography), which assesses brain metabolism, or SPECT (single photon emission computerised tomography), which researchers hope will help separate the treatable and non-treatable causes of dementia.

None of these tests is painful for the patient, but the setting and fear of what they might find will almost certainly make it an unpleasant experience.  Reassurance and support from friends and family all help to render the event less traumatic.

As Alzheimers cannot be identified in certainty during life, it may take several trips to the doctor before the diagnosis is finally made.  If you are at all unhappy about your treatment, or if you feel that a diagnosis was made too quickly without sufficient testing, dont be afraid to ask for a second opinion.

03/06/2009