Dementia Diagnostics: Identifying the Enemy

My recent social media posts have revolved around signs and symptoms of early-stage dementia. Frequently after I’ve given a talk at a conference or a workshop for caregivers, people will ask me if I think certain behaviors they’ve noticed in their loved one are indicative of dementia. I find myself wanting to be able to give them the comfort of a definitive “yes” or “no” answer, but the reality is that by its very nature a true dementia diagnosis is difficult to make, and the lengthy list of potential symptoms only seems to muddy the waters further:

• Memory impairment
• Difficulty concentrating
• Trouble finishing tasks
• Confusion over passage of time
• Getting lost
• Misplacing items
• Inability to find the right word
• Withdrawal from social engagements
• Changes in mood

I’ve also had people ask me if struggling to come up with the right word or forgetting where they put their keys means that a dementia diagnosis is imminent for them. In a word, no; you can put your mind at ease because everyone experiences these things from time to time. It becomes problematic when several of these symptoms appear overlapping each other, and the result is a disruption of daily life.

There is currently no conclusive diagnostic “test” that doctors can use to determine the presence of dementia—even though blood tests and scans are able to help narrow down the issue. In order to diagnose a patient with dementia, members of the medical community are still largely reliant on their own observations—as well as the reports of close family members. The effort to make an accurate dementia diagnosis ultimately involves several different things. One of the first actions a doctor will take is an attempt to rule out other conditions as the underlying cause of the symptoms that are presenting. There are a number of disorders that can cause or imitate the symptoms of dementia such as vitamin B12 deficiency or an underactive thyroid. If the true problem is addressed, the troubling symptoms can clear up.

If no other issues are found to explain the dementia-like symptoms, the doctor will begin assessing memory or behavioral problems that have been observed. Their evaluations can include laboratory tests, brain-imaging such as MRI, CT or PET scans, and neuropsychological testing to evaluate memory and cognitive (thinking) skills. These cognition tests examine orientation and memory, and they require the patient to identify certain objects by name, follow verbal and written commands, and copy a complex shape.

One of the most commonly used cognition tests is the Mini-Mental State Exam (MMSE). The MMSE scores range from 0 to 30, and a score of 26 or higher is generally considered to be in the normal range. Scores between 10 and 20 indicate a moderate level of dementia, and scores below 9 indicate severe impairment.

Early detection is key; if you suspect your loved one is having a problem, get it checked out by their physician. Ignoring unusual behaviors can lead to unsafe activities: your loved one might leave a stove eye on or a faucet running, or they may even wander away from home. Don’t just speculate about what’s going on; because you love them, go find out what—if anything—is up!