brain, spinal cord, and nerve disorders
Dementia
Diagnosis of Dementia
A doctor's evaluation Mental status testing Sometimes neuropsychologic testing Blood tests and imaging tests to rule out causes Forgetfulness is usually the first sign of dementia noticed by family members or doctors. Doctors and other health care practitioners can usually diagnose dementia by asking the person and family members a series of questions, such as the following: What is the person’s age? Has any family member had dementia or other types of mental dysfunction (family history)? When and how did symptoms start? How quickly did symptoms worsen? How has the person changed (for example, has the person given up hobbies and activities)? What other disorders does the person have? What drugs is the person taking (because certain drugs can cause symptoms of dementia)? Has the person been depressed or sad, especially if the person is older? The person is also given a Mental Status , consisting of simple questions and tasks, such as naming objects, recalling short lists, writing sentences, and copying shapes. To test for memory, doctors may read a list of three objects, wait 5 minutes, then ask the person to list them. Usually, people with dementia cannot remember them. Neuropsychologic testing,which is more detailed, is sometimes needed to clarify the degree of impairment or to determine whether the person is experiencing true mental decline. This testing covers all the main areas of mental function, including mood, and usually takes 1 to 3 hours. This testing helps doctors distinguish dementia from age-associated memory impairment, mild cognitive impairment, and depression. With information about the person’s symptoms and family history and the results of mental status testing, doctors can usually diagnose dementia. Based on this information, doctors can also usually rule out delirium as the cause of symptoms (see table Comparing Delirium and Dementia ). Doing so is essential because delirium, unlike dementia, can often be reversed if promptly treated. Findings that indicate dementia include the following: People have problems with thinking and behavior that interfere with doing daily tasks. These problems have become progressively worse, making doing daily tasks more and more difficult. People do not have delirium or a psychiatric disorder that could be causing the problems. In addition, people have at least two of the following: Difficulty learning and remembering new information Difficulty using language Difficulty understanding where objects are in space, recognizing objects and faces, and understanding how parts of a whole relate to each other Difficulty planning, solving problems, handling complex tasks (such as managing a bank account), and using good judgment (executive function) Changes in personality, behavior, or demeanor A physical examination, including a Neurologic Examination , is usually done to determine whether other disorders are present. Doctors look for treatable disorders that may be causing, contributing to, or mistaken for dementia. Doctors also determine whether another, unrelated physical disorder or psychiatric disorder (such as schizophrenia) is also present because treatment of these disorders may improve the general condition of people with dementia. Blood tests are done. They typically include measuring blood levels of thyroid hormones to check for thyroid disorders and levels of vitamin B12 to check for a deficiency. If doctors suspect that the cause of dementia is an infection that affects the brain (such as neurosyphilis), an autoimmune disorder, or prion disease, a Spinal Tap (lumbar puncture) is done. Computed Tomography (CT) (CT) or Positron Emission Tomography (PET) (PET) or However, sometimes the cause of the dementia can be confirmed definitively only when a sample of brain tissue is removed and examined under a microscope. This procedure is sometimes done after death during an autopsy. 