As people get older, it is common to forget more things, have more trouble finding the right words, or lose things more often. But, when changes in memory and thinking begin to affect a person’s daily life and activities, it is time to be concerned and to find out what the problem is.
If you are concerned about changes in memory and thinking or changes in senses, behavior, mood, or movement that do not seem normal in yourself or a family member, talk to a doctor. See Symptoms for more information.
A good place to start is with your primary care doctor. Although your doctor may not specialize in cognition problems, he or she might administer brief memory screening tests that can help detect problems. The doctor can do a complete exam to find out if a physical or mental health issue is causing the problem.
Another reason to start with your primary care doctor is that he or she has your medical history, which is important background information for a diagnosis. Your relationship with your primary care doctor also may help you talk about sensitive issues. Your doctor may know you well enough to spot changes in your memory and thinking. He or she can refer you to the right kinds of specialists.
How is Alzheimer’s disease diagnosed?
Doctors have several methods and tools to help them determine fairly accurately whether a person with memory problems has “possible Alzheimer’s disease,” “probable Alzheimer’s disease,” or some other problem. “Possible Alzheimer’s disease” means the symptoms may be from another cause. “Probable Alzheimer’s disease” means no other cause for the symptoms can be found. A definitive diagnosis of Alzheimer’s disease can be made only through autopsy after death.
To diagnose Alzheimer’s in a living person, a physician will:
- ask questions about a person’s overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
- conduct tests of memory, problem solving, attention, counting, and language skills
- carry out medical tests, such as tests of blood, urine, or spinal fluid
- perform brain scans, such as a computed tomography (CT) or positron emission tomography (PET) scan or a magnetic resonance imaging (MRI) test
These tests may be repeated to give doctors information about how the person’s health and memory are changing over time. Sometimes these tests help doctors find other possible causes of the person’s symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood-vessel disease in the brain can cause Alzheimer’s-like symptoms. Some of these other conditions can be treated successfully.
Such tests also can help diagnose other causes of memory problems. These problems include mild cognitive impairment and vascular dementia. Mild cognitive impairment is a medical condition that causes people to have more memory problems than other people their age. Vascular dementia is a medical condition caused by small strokes or changes in the brain’s blood supply. For more information, see Understanding Memory Loss.
What are other options for assessment and diagnosis?
If the primary care doctor suspects mild cognitive impairment (MCI) or possible Alzheimer’s, he or she may refer you to a specialist who can provide a detailed diagnosis, or you may decide to go to a specialist for further assessment. You can find specialists through memory clinics and centers or through local organizations or referral services. Some types of specialists include:
- Geriatricians, who manage health care in older adults. They know how the body changes as it ages and whether symptoms indicate a serious problem
- Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems
- Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans
- Neuropsychologists, who can conduct tests of memory and thinking
Memory clinics and centers, including Alzheimer’s Disease Research Centers, offer teams of specialists who work together to diagnose the problem. For example, a geriatrician can look at your general health, a neuropsychologist can test your thinking and memory, and a neurologist can use scanning technology to “see” inside your brain. Tests often are done at the clinic or center, which can speed up diagnosis.
You may also want to get a second opinion. Diagnosis of memory and thinking problems can be challenging. Subtle signs and symptoms may be overlooked or unclear. Getting a second opinion helps to confirm the diagnosis. Most doctors understand the benefit of a second opinion. They will share your records, if you permit. A specialist can refer you to another doctor for a second opinion, or you may decide to find one yourself.
What are the benefits of early diagnosis?
Early diagnosis is beneficial for several reasons. Having an early diagnosis and starting treatment in the early stages of Alzheimer’s disease can help preserve function for months to years, even though the underlying Alzheimer’s process cannot be changed. Also, researchers studying new therapies are finding that treatment may be more effective earlier in the disease process than later.
Having an early diagnosis also helps patients and their families:
- plan for the future
- make living arrangements
- take care of financial and legal matters
- develop support networks
Finally, an early diagnosis can provide greater opportunity for people with Alzheimer’s disease to get involved in clinical trials. Clinical trials are research studies in which scientists test the safety, side effects, or effectiveness of a medication or other intervention.
To learn more about Alzheimer’s disease clinical trials:
- talk with your health care provider
- contact NIA’s Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380
- visit the Alzheimer’s Disease Clinical Trials database or www.ClinicalTrials.gov
You may also sign up for ADEAR Center email alerts that let you know when new clinical trials are added to the Alzheimer’s Disease Clinical Trials database.
What new methods for diagnosing Alzheimer’s disease are being studied?
Scientists are exploring ways to help physicians diagnose Alzheimer’s earlier and more accurately. The ultimate goal is a reliable, valid, inexpensive, and early diagnostic test that can be used in any doctor’s office.
Some studies focus on changes in personality and mental functioning, measured through memory and recall tests, which might point to early Alzheimer’s or predict whether individuals are at higher risk of developing the disease. Other studies are examining the relationship between early damage to brain tissue and outward clinical signs.
Another very promising area of diagnostic research is the analysis of body fluids—blood and cerebrospinal fluid—to look for specific proteins, such as tau and beta-amyloid proteins, which are commonly found in people with Alzheimer’s.
One of the most exciting areas of diagnostic research is neuroimaging. Scientists have developed sophisticated imaging systems that may help measure the earliest changes in brain function or structure to identify people in the very first stages of Alzheimer’s—well before they develop apparent signs or symptoms.
The National Institute on Aging’s Alzheimer’s Disease Neuroimaging Initiative is a large study that uses MRI and PET scans to learn when and where in the brain changes occur as memory problems develop. These types of neuroimaging scans are still primarily research tools, but they may be used more commonly in the future to help physicians diagnose Alzheimer’s at very early stages.
For more information on the promising new developments in diagnostic research for Alzheimer’s disease, see the ADEAR Center publication Alzheimer’s Disease: Unraveling the Mystery.
Other questions? Call the ADEAR Center at 1-800-438-4380 or e-mail our information specialists.