Ways of detecting early-stage dementia

The early symptoms of dementia can include memory problems, difficulties in word-finding and thinking processes, changes in personality or behavior, a lack of initiative, or changes in day-to-day function at home, at work, or in taking care of oneself. This information does not include details about all of these warning signs, so it is recommended that you seek other sources of information. If you notice signs in yourself or in a family member or friend, it is important to seek medical help to determine the cause and significance of these symptoms.

Obtaining a diagnosis of dementia can be a difficult, lengthy and intensive process. While circumstances differ from person to person, Dementia Australia believes that everyone has the right to:

• A thorough and prompt assessment by medical professionals,
• Sensitive communication of a diagnosis with appropriate explanation of symptoms and prognosis,
• Sufficient information to make choices about the future,
• Maximal involvement in the decision-making process,
• Ongoing maintenance and management, and
• Access to support and services.

For some people, there may be barriers to diagnosis, especially to an early diagnosis. These include the belief that memory problems are a normal part of aging, the perceived stigma attached to dementia, the lack of a cure, and fear about the future. However, there are many reasons why early diagnosis is important, some of which are detailed on this page. Early diagnosis and awareness about dementia are the first steps in designing management strategies. As more effective treatments become available in the future, early diagnosis will become even more important.

What are the benefits of early diagnosis?

Early planning and assistance

Early diagnosis enables a person with dementia and their family to receive help in understanding and adjusting to the diagnosis and to prepare for the future in an appropriate way. This might include making legal and financial arrangements, changes to living arrangements, and finding out about aids and services that will enhance the quality of life for people with dementia and their family and friends. Early diagnosis can allow the individual to have an active role in decision making and planning for the future while families can educate themselves about the disease and learn effective ways of interacting with the person with dementia.

Checking concerns
Changes in memory and thinking ability can be very worrying. Symptoms of dementia can be caused by several different diseases and conditions, some of which are treatable and reversible, including infections, depression, medication side effects, or nutritional deficiencies. The sooner the cause of dementia symptoms is identified, the sooner treatment can begin. Asking a doctor to check any symptoms and to identify the cause of symptoms can bring relief to people and their families.

Treatment
There is evidence that the currently available medications for Alzheimer’s disease may be more beneficial if given early in the disease process. These medications can help to maintain daily function and quality of life as well as stabilize the cognitive decline in some people; however, they do not help everyone and they are not a cure. Early diagnosis allows for prompt access to medications and medical attention.

Health management
Receiving a diagnosis can also help in the management of other symptoms which may accompany the early stage of dementia, such as depression or irritability. Also reviewing the management of other medical conditions is critical, as memory problems may interfere with a person remembering to take important medications such as diabetes, heart disease, or high blood pressure.

Current practice in diagnosing dementia

The remainder of this information will provide an overview of the diagnosis process and a guide to what happens after the diagnosis.

It is important to remember that there is no definitive test for diagnosing Alzheimer’s disease or any of the other common causes of dementia. Findings from a variety of sources and tests must be pooled before a diagnosis can be made, and the process can be complex and time-consuming. Even then, uncertainty may still remain, and the diagnosis is often conveyed as “possible” or “probable”. Despite this uncertainty, a diagnosis is accurate around 90% of the time.

People with significant memory loss without other symptoms of dementia, such as behavior or personality changes, may be classified as having a Mild Cognitive Impairment (MCI). MCI is a relatively new concept and more research is needed to understand the relation between MCI and later development of dementia. However, MCI does not necessarily lead to dementia and regular monitoring of memory and thinking skills is recommended in individuals with this diagnosis.

The diagnosis process

The first step in the diagnosis process is to assess symptoms through a thorough medical history, physical examination, and evaluation of memory and thinking abilities. Other causes of dementia-like symptoms must be ruled out through laboratory tests and in some cases, brain scans. The next step is to determine the cause of dementia, most commonly Alzheimer’s disease, vascular dementia, Lewy body dementia, or frontotemporal dementia.

Medical history

The doctor will obtain a complete medical and family history. Questions will be asked about forgetfulness, orientation, problem-solving, coping with everyday life, alcohol consumption, and medication usage. The doctor needs to establish when the change in function was first noticed, whether the change was sudden or gradual and whether the person’s difficulties are getting worse. Determining the onset and progression of symptoms can help to differentiate types of dementia. Descriptions of the person’s difficulties from family members, obtained if the person consents are vital in the diagnosis process.

Medical testing

• Medical tests, including blood, urine, and genetic tests, as well as brain scans, are sometimes used in the diagnosis of dementia.
• Blood or urine tests are carried out to exclude other causes of dementia symptoms, by testing for infections, vitamin and nutrient levels, as well as kidney, liver, and thyroid function. Psychological evaluation

Tests of mental functioning are very important in the diagnosis process. These tests are used to determine the extent of any memory or thinking problems and can be used to track progression over time.

Brief screening tests can be followed up by more detailed tests of mental function. These tests are known as neuropsychological tests and examine different areas of function such as memory, language, reasoning, calculation, and ability to concentrate.

These tests are able to distinguish between different patterns of decline and are therefore important in helping to identify the type of dementia affecting the individual.

Types of Dementia

There are many different causes of dementia. The most common is Alzheimer’s disease, which is associated with distinctive changes in the brain. While Alzheimer’s disease can develop in younger people, it is most common after the age of 65 years. Vascular dementia is thought to be the second most common form of dementia and is associated with problems of blood circulation in the brain. However, mixed dementia containing elements of vascular dementia and Alzheimer’s disease is also common.

Future directions in diagnosis research

The considerable research effort is being put into the development of better tools for accurate and early diagnosis. Research continues to provide new insights that in the future may promote early detection and improved diagnosis of dementia, including:

• Better dementia assessment tests that are suitable for people from diverse educational, social, linguistic, and cultural backgrounds.
• New computerized cognitive assessment tests can improve the delivery of the test and simplify responses.
• Improved screening tools to allow dementia to be more effectively identified and diagnosed by GPs.
• The development of blood and spinal fluid tests to measure Alzheimer’s related protein levels and determine the risk of Alzheimer’s disease.
• The use of sophisticated brain imaging techniques and newly developed dyes to directly view abnormal Alzheimer’s protein deposits in the brain, yielding specific tests for Alzheimer’s disease.

After the diagnosis

Early diagnosis of dementia is the first step in understanding and managing the condition. Communicating a diagnosis of dementia can allow for planning to begin. Early diagnosis of dementia means that in the vast majority of cases, it is appropriate for people to be told about their diagnosis, as they have a right to information about their health.

In the past, some people argued against telling a person of their diagnosis because of the belief that there is no benefit in knowing, the fear of provoking distress, and that the diagnosis would be difficult for the person to understand. However, although many people with early-stage dementia will initially feel ‘shattered’ by the diagnosis, many also say that they feel a sense of relief that the cause of their difficulties is identified, and knowing the diagnosis can increase their sense of independence and enable an active role in planning for their future.

It can be difficult to take in information at the time of diagnosis, so scheduling another time to talk to the doctor is important. Take time and ask as many questions as you like. It may also be helpful to have someone supportive with you at the time of diagnosis. You may want to ask your doctor about the possible benefits of medication and side effects.