ALL ABOUT ALZHEIMER'S: Getting a Diagnosis  
By Betty Weiss

Lots of luck getting a straightforward diagnosis when there is a memory problem.  Even if told it is Alzheimer's, two years later it might all change to something else, like Lewy body disease or frontotemporal dementia.  Further, other illnesses and certain life-styles, like excessive alcohol, may be contributing factors to memory loss.

In addition to your regular doctor you might also consider a geriatrician; or a neurologist specializing in brain disorders; or a psychiatrist specializing in mood disorders and how the brain works; or a psychologist with specialized training in testing memory, problem solving, language and other mental functions.  These are only suggestions--don't think you will want to see them all!  Your doctor can help sort them out.  Someone should go into the exam room with memory loss patients because they forget what the doctor told them before they walk out.

There is no exact test that proves someone has Alzheimer's.  A medical workup will determine overall health and might identify something else that may be causing memory problems.  It's a matter of elimination.  If nothing else is found to be causing memory loss, it may be a diagnosis of 'probable' Alzheimer's that is 85-90% effective but only 100% verifiable at autopsy.

The doctor will ask what symptoms the patient has been having, so consider starting a journal when an awareness of memory loss begins.  It will help him understand when symptoms began, when they happen and if they've gotten worse.  He will evaluate the person's sense of well-being, look for depression, other mood disorders, loss of interest in life and any symptoms that can come with dementia.  He'll ask about diet and nutrition; check blood pressure, temperature and pulse; listen to heart and lungs; and collect samples of blood and urine.  A neurological exam to assess the functioning of the brain and nervous system may identify a brain disorder other than Alzheimer's, so he'll test reflexes, coordination, balance, muscle tone, strength, eye movement, speech and sensation.  A brain scan may be called for.

He will interview family members because the patient may not be fully aware of what is happening.  Unconscious adjustments are often made by others to adapt to the patient.  Asking a spouse or adult child if they feel uneasy leaving the patient alone helps the doctor get an idea of how intimate relationships may have been subtly changing.  The doctor will want to know of any medical conditions that affect other family members, especially if someone may have had Alzheimer's or a related disorder.  Take the containers of all prescriptions and over-the-counter medicines plus any vitamins or supplements so the doctor can read dosages and look for interactions or side effects.  Have all questions written down so you won't forget anything.

A mini-mental state exam (MMSE) will give the doctor an idea of whether or not the patient is aware of  symptoms and will be asked what year, season, date and day of the week it is; count backwards from 100 by 7's; spell 'world' backwards.  He will be asked to remember three simple things like a car, a tree and a book.  Then the doctor will chat for a bit and ask the patient to name the three items.  He may also be shown and asked to name a few things in the office like a pen, a clock, a phone.  He could be asked if he knows where the doctor's office is, to complete a common phrase and copy a picture of two interlocking shapes or draw a clock showing the 12 numbers in the right places.  There will likely be a three-part instruction, such as: take a paper in your right hand, fold it in half, and put it on the floor.

The MMSE is judged on 30 points.  A score of 20-24 is mild dementia, 13-20 is moderate, and less than 12 indicates severe dementia.  On average the MMSE score with Alzheimer's patients declines about 2-4 points a year.

It is frustrating, but important, to realize that medical science is not perfect. Missing clues and misdiagnosing Alzheimer's and other memory problems is not uncommon.  Most doctors try their best, but sometimes it may be 'by guess and by golly.'  If you feel yours is not doing everything possible, don't hesitate to go elsewhere. 

Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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