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Diagnosis of dementia and Alzheimer's disease

Video transcript

- [Voiceover] So there isn't one stand-alone test that will show whether someone has dementia or Alzheimer's disease, since the typical symptoms like memory loss, confusion, and others, can have a whole slew of potential causes. That being said, it's not usually diagnosed until a complete medical assessment is performed. But what all does that entail? Well, first off, a healthcare professional might take a look at the patient's history. They'll try to gather information from the patients themselves as well as from their friends and family. They'll probably ask questions like what kind of symptoms have you noticed? Or when did you start noticing them? How often do they happen? And have you noticed them getting any worse? They'll also try to evaluate the patient's emotional state. A lot of the time the patient might be completely unaware of their current state or they might be in denial about it. And this can be tough because sometimes even other family members will deny its progression because many of the early signs of dementia also tend to look just like normal signs of aging. And this is just another reason why it makes diagnosis of dementia very, very hard and why we have to rely on other methods of diagnosis as well. So a physical examination can also be done. In these, your doctor will check things like your hearing or your eyesight, your heart and your lungs, your temperature, your blood pressure, and your pulse. And they may also take things like blood and urine samples. Information from these can help the doctor figure out if there are any other underlying health issues that are causing or contributing to the dementia itself, like heart problems and vascular dementia or if there's another condition that's mimicking symptoms of dementia, since other conditions like anemia or depression, infection, diabetes, kidney disease, and others can also cause dementia-like symptoms, like confused thinking and memory problems. But besides physical exams, a neurological evaluation may also be done. And this'll look at the patient's nervous system and will test things like balance and sensory function using lights and also your reflexes, using that tiny hammer and lightly tapping it on the knee. The doctor might also give the patient a cognitive or a neuropsychological test, which are used to kind of objectively measure the patient's current memory, language skills, math skills, and other abilities as they relate to mental function. And one big one's called the mini mental state examination or MMSE. And this test can be particularly helpful in diagnosing dementia because it looks at orientation, memory, and attention. For example, it might ask to follow verbal or written commands or write down a sentence spontaneously or copy a complex shape. And depending on the score, a certain level of dementia might be suggested. Scores of about 20 to 24 suggest mild dementia, 13 to 20 suggests moderate dementia, and less than 13 would suggest a severe case of dementia. And typically patients with Alzheimer's disease tend to drop two to four points on average every year. Another more simple test that might be administered is called the mini-cog test. In this test the patient is asked to name three objects and then repeat them back to the doctor, like car, chair, and mug. For the next part, the patient is asked to draw an analog clock and also asked to draw a specific time. Thirdly, the patient's asked what those three objects initially were, car, chair, and mug. If the patient fails one or all of these tests, it might suggest signs of dementia and may require a further evaluation. Another potential test is the psychiatric evaluation or mood assessment. They'll try to assess the patient's current level of well-being, looking for signs of depression or other mood disorders that can also contribute to symptoms that overlap with dementia symptoms. Finally, the patient might have brain scans. With a brain scan the brain's actually visualized through techniques like computed tomography or CT scans or magnetic resonance imaging or MRI. And there are several reasons why we might want one these performed. They might be useful in identifying larger masses, like tumors, that can be contributing to the cognitive impairment. But it might also help in making a differential diagnosis, meaning that we'll try to look to figure out what type of dementia is at play. Sometimes by looking at where the most atrophy of brain tissue is localized, we can figure out what type of dementia it is. For example, atrophy that's localized to the hippocampus might suggest Alzheimer's disease or the frontal lobe might suggest frontotemporal dementia or vascular pathologies that are visualized might suggest vascular dementia. And another reason for a brain scan might be to monitor disease progression. Several imaging sessions over several years might show how the brain has changed over time. More atrophy might be indicative of disease progression whereas if the atrophy has stayed the same over time, it might suggest that a different or a more static cognitive disease is at play. Finally, imaging is really, really valuable for research purposes, especially with respect to structural imaging and figuring out which structures are affected first by the disease in addition to any chemical processes that might be involved. And this information helps physicians and researchers alike understand dementia as a disease and develop more effective treatments in the future.