Because diagnosing dementia can be so tricky, if you suspect a relative may have Alzheimer’s disease, bypass your family doctor. Visit someone with special training – an internist, a neurologist, a psychiatrist, or a psychologist who is trained in geriatrics. Preferably, get your relative evaluated at a hospital-based geriatric center.

Visiting a center is preferable to seeing any sole practitioner for several reasons: experts from several disciplines will collaborate in making the diagnosis,- procedures and diagnostic tests are more likely to be state of the art; the fee may be less prohibitive (Medicare will pay for most of the cost in any case, because dementia has been reclassified from a psychiatric to a neurological disorder); and if your fears are justified and the problem is dementia, you will be thoroughly briefed on your options and on what to expect.

We would imagine that any humane doctor would sit down with a family and carefully explain the situation after delivering a diagnosis of this magnitude. Not true! In the University of Michigan study of family members most people gave shocking accounts of how they were told the facts. Some said that the curt words, “He will gradually deteriorate, becoming completely helpless,” were delivered in a waiting room or an elevator. Or the same diagnosis might be heedlessly offered while the patient was standing right there. Not only were families understandably bitter about this insensitivity, they were left ill equipped to understand the problems they would eventually have. Of the 289 People in this study, only three said their doctors had called a family conference to thoroughly explain what the diagnosis meant.

A history of the problem. Because a pattern of insidious development is a major clue indicating dementia, a primary diagnostic tool is a careful medical history. When you visit, be prepared to describe exactly what has been going on. How long have you noticed the problems? Have the symptoms gotten progressively worse? What difficulties were there to begin with, and what occur now? Did any event – an illness, a loss such as widowhood, or a fall – predate the problems?

You will be asked about current and past illnesses, depression, the medications your relative is taking. Because chemical toxins can cause memory problems, you may be asked about long-term exposure to chemicals.

A complete physical and neurological examination. A thorough physical examination will be done. Urine will be tested,-blood will be drawn; neurological and memory tests may be administered. Particularly if the impairments are subtle, a psychologist may administer a battery of neuropsychological tests. These tests, winch can be invaluable in the differential diagnosis of dementia, are somewhat like the paper-and-pencil measures of abilities we get in school.

Measures of brain function. An EEG, a CAT scan or a PET scan may also be given. The EEG (electroencephalogram) measures the electrical activity of different areas of the brain Electrodes are attached to the scalp, and a machine traces brain waves.

The CAT scan and PET scan, also safe, painless procedures, provide pictures of the brain. The CAT scan is like an X-ray in three dimensions. A computer generates a picture of the brain’s mass. The PET scan measures the brain’s consumption of glucose. By using this newer, only occasionally available test, doctors can tell which areas of the brain are functioning well (metabolizing glucose normally) and which are not (areas where glucose consumption is abnormally low).

The CAT scan can rule out other reasons for mental changes such as brain tumors. When the PET scan shows extensive areas of low glucose metabolism, it can confirm that dementia is severe, but neither test can prove the existence of a condition such as Alzheimer’s disease. Although both techniques are wonderful for diagnosing other neurological conditions, neither allows the direct examination of the brain cells that is necessary to positively diagnose Alzheimer’s disease.

Luckily, despite the difficulty of absolutely proving a person has dementia, if you do visit a center staffed by knowledgeable professionals, you can have confidence in the diagnosis you get. When researchers followed two hundred patients evaluated at a geriatric clinic specializing in the diagnosis and treatment of dementia for a year, they found very few diagnostic mistakes. If a person had been diagnosed as having dementia, over time that diagnosis was almost always confirmed.

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GENERAL HEALTH