Alzheimer Test, Screening & Diagnosis
There are a number of different assessments your doctor may use if it is suspected that you have Alzheimer’s disease. As with the diagnosis of many diseases, your evaluation will usually start out as a general assessment of your health and get more specific as causes for your symptoms are ruled out.
Physical Exam
Often, the first step when Alzheimer’s symptoms appear will be to do a physical exam to see if there may be some other explanation for your relevant symptoms. Memory issues and confusion can be caused by conditions such as depression, anemia, diabetes, thyroid deficiencies, and infections.
Neurological Exam and Brain Imaging
After a general physical exam, more specific exams will likely be undertaken if the physician believes that your symptoms have arisen due to issues within the brain. The goal of these tests is to rule out other brain conditions that could cause your symptoms. A neurological exam will likely be performed to rule out brain tumors, Parkinson’s disease, and stroke. The neurological test assesses your senses, reflexes, coordination, speech, and eye movement. Another way that brain issues other than dementia or Alzheimer’s disease are ruled out is brain imaging. Techniques like CT scans and MRIs can identify tumors, fluid buildup, and evidence of head trauma or strokes.
Mental Status Tests
To test specifically for Alzheimer’s disease, neurologists will often employ mental status tests that assess problem-solving, memory, and other cognitive thinking skills, as well as the person’s mood. Mood is tested because some mood disorders can cause some of the same symptoms as Alzheimer’s disease, such as depression, apathy, and memory loss and so can help rule out these other mental health issues.
The two tests that are used most often are called the mini-cog and the mini-mental state exam (MMSE). The mini-cog is a simple test that enables a doctor to decide whether someone needs to be more comprehensively evaluated for dementia. If you take the mini-cog, you will be asked to remember 3 objects over the course of a few minutes. You will also draw a clock with a specific time indicated by the person implementing the test.
Taking the MMSE involves answering relatively simple questions the physician asks that test mental abilities that are used in everyday life. The highest score one can receive on the MMSE is a 30, which would indicate healthy mental status. Mild dementia is associated with a score between 20 and 24, whereas moderate dementia is associated with a score between 13 and 20. A score below 13 represents severe dementia. For those suffering from Alzheimer’s disease, MMSE scores generally drop between 2-4 points per year.
Genetic Testing
Genetic testing can be performed to determine if you carry the apolipoprotein E-E4 (APEO-e4) gene, which significantly increases the risk for Alzheimer’s disease. However, though having this specific form of the gene increases the risk for developing Alzheimer’s disease, identifying it does not prove that you have or will develop Alzheimer’s disease. Similarly, you can be tested to see if you carry genes for the type of Alzheimer’s disease that is inherited. However, in this case, the outcome of the test does determine whether you will develop Alzheimer’s disease. Many people with family members with Alzheimer’s disease will undergo this test, whereas others choose not to.
Home Screening
There are several home screening tools that have been developed to allow people to assess their likelihood of having dementia or Alzheimer’s disease. The reliability of these techniques vary, and their utility can be controversial. However, these tests offer a simple and convenient way to begin assessing whether you may suffer from neurological deficits.
References
Ala, T. A., Hughes, L. F., Kyrouac, G. A., Ghobrial, M. W., & Elble, R. J. (2002). The Mini-Mental State exam may help in the differentiation of dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry, 17(6), 503-509. doi: 10.1002/gps.550
Calza, L., Beltrami, D., Gagliardi, G., Ghidoni, E., Marcello, N., Rossini-Favretti, R., & Tamburini, F. (2015). Should we screen for cognitive decline and dementia? Maturitas, 82(1), 28-35. doi: 10.1016/j.maturitas.2015.05.013
Fage, B. A., Chan, C. C., Gill, S. S., Noel-Storr, A. H., Herrmann, N., Smailagic, N., . . . Seitz, D. P. (2015). Mini-Cog for the diagnosis of Alzheimer’s disease dementia and other dementias within a community setting. Cochrane Database Syst Rev, 2, CD010860. doi: 10.1002/14651858.CD010860.pub2
Gauthier, S., Leuzy, A., Racine, E., & Rosa-Neto, P. (2013). Diagnosis and management of Alzheimer’s disease: past, present and future ethical issues. Prog Neurobiol, 110, 102-113. doi: 10.1016/j.pneurobio.2013.01.003
Lin, J. S., O’Connor, E., Rossom, R. C., Perdue, L. A., Burda, B. U., Thompson, M., & Eckstrom, E. (2013). Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force. Rockville MD.
McCarten, J. R., Rottunda, S. J., & Kuskowski, M. A. (2004). Change in the mini-mental state exam in Alzheimer’s disease over 2 years: the experience of a dementia clinic. J Alzheimers Dis, 6(1), 11-15.
Van Cauwenberghe, C., Van Broeckhoven, C., & Sleegers, K. (2015). The genetic landscape of Alzheimer disease: clinical implications and perspectives. Genet Med. doi: 10.1038/gim.2015.117
Weiner, M. W., & Veitch, D. P. (2015). Introduction to special issue: Overview of Alzheimer’s Disease Neuroimaging Initiative. Alzheimers Dement, 11(7), 730-733. doi: 10.1016/j.jalz.2015.05.007