The initial assessment
The initial assessment is the first step your family doctor will take to determine whether or not you have dementia.
In the initial assessment, your doctor will ask you questions about your medical history and have you take some physical and cognitive exams. Doing so will help your doctor eliminate other possible causes and provide them with more information to reach a diagnosis.
Questions about your medical history
Your doctor will need detailed information about your medical history, including the symptoms you're noticing and your current health and lifestyle. These questions may sound like:
- What are your symptoms like? Can you describe them?
- When did you start noticing these symptoms?
- What's your family medical and psychiatric history?
Mental status exam
Your doctor may also conduct mental tests to measure your sense of time and place, as well as your ability to remember, express yourself, and perform simple calculations. This may involve exercises such as recalling words and objects, drawing and spelling, and questions such as "What year is it?”
An example of a mental status exam is the Montreal Cognitive Assessment (MoCA), a test that measures judgement, planning, problem-solving, reasoning and memory.
To help rule out other causes, your doctor may conduct a physical exam:
- The doctor will look for heart, lung, liver, kidney or thyroid problems that may be causing the symptoms.
- To evaluate whether another nervous system disorder may be causing the symptoms, your doctor may also test muscle tone and strength, coordination, eye movement, speech and sensation.
- Your doctor may also conduct a number of tests that will measure your blood pressure, cholesterol levels, thyroid function and vitamin levels.
After an initial assessment, your doctor may feel like they have the information they need to make a conclusive diagnosis. If not, they may recommend you for more exams that involve laboratory work. Laboratory tests take more time, but they will help ensure that your diagnosis is accurate.
Your doctor may have you undergo detailed blood work. These tests will look out for any underlying heart, lung, liver, kidney or thyroid problems that may be causing your symptoms.
Brain imaging tests
A number of brain imaging tests may also be required to see if there is evidence of a recent stroke or changes to your brain’s blood vessels, such as bleeding.
In some centres, scans may be used. The following brain imaging tests may be recommended, but are not always necessary for a diagnosis:
- Computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan. These take images of your brain, showing its structure. Through CT and MRI scans, doctors can also tell if there is any shrinkage of the brain happening.
- Single proton emission computed tomography (SPECT) scan. This shows how blood is circulating through your brain.
- Positive electron tomography (PET) scan. This shows how the different areas of your brain respond during certain activities such as reading and talking. This scan is usually done after 45 minutes of rest.
Other laboratory tests
Other tests such as X-rays and electroencephalograms (EEGs) may be used to determine the source of the problem.
Referral to a specialist
Your doctor may also recommend you go to a memory clinic or other specialist service for more testing. If you feel that a referral would be helpful and your doctor does not suggest it, you can request it.
A qualified specialist could be a psychologist, psychiatrist, neurologist, geriatrician, nurse, social worker or occupational therapist. They will look for problems with your memory, reasoning ability, language and judgment, and how these affect day-to-day function.
Here are some of the specialists you may be referred to:
A neurologist specializes in disorders of the brain and nerve pathways. Some neurologists have particular experience in diagnosing dementia.
A geriatrician specializes in physical illnesses and disabilities associated with old age and in the care of older people.
A psychiatrist specializes in diagnosing and treating a wide range of mental health problems. A psychiatric evaluation may be helpful in ruling out other illnesses such as depression, which can cause symptoms similar to those associated with Alzheimer's disease.
These specialists can also cross over into each other's areas:
- Neuropsychological testing can evaluate your memory, reasoning, and writing abilities.
- Geriatric psychiatrists are psychiatrists who have further specialized in the mental health of older people, including dementia.
After the exams are complete, you will likely continue to see your family doctor for ongoing assessment.
If you get a diagnosis of dementia, make an appointment to see your family doctor from time to time to assess changes and discuss any problems.
Your doctor can still help you in many ways. They can:
- Refer you to a specialist for help in assessing changes,
- Give you advice on ways to deal with specific difficulties you face and
- Through referral services like First Link®, connect you to your local Alzheimer Society and programs and services in your community. These programs and services can provide you with dementia education, resources and support that can help you maintain your quality of life.
Your family doctor is also responsible for your general health when you have dementia.
Key points to know
- There is no single, specific test that can diagnose dementia.
- Diagnosis of dementia is made through a systematic assessment, involving your medical history and a number of tests, that eliminates other possible causes.
- Because there can be a lot involved in the process of diagnosis, including laboratory tests and referrals to specialists, getting an official, conclusive diagnosis can take some time.
- Only your doctor or a qualified specialist, such as a neurologist or a psychologist, can give you an official diagnosis.
- Online self-assessments that claim they can effectively diagnose you can be inaccurate, misleading and put you at risk.
- Until the official, conclusive diagnosis is reached, doctors may continue to use the words “probable Alzheimer’s disease” or "probable dementia". But until then, don't assume that you certainly have (or don't have) dementia.
- If you are diagnosed with dementia, keep meeting with your doctor to note changes in your abilities and assess problems you may face. There are recommended first steps to take after diagnosis that you can follow.
More useful links and resources
Getting a diagnosis. Alzheimer Society of Canada. This downloadable brochure summarizes what you need to know about getting a diagnosis, including how to prepare for your assessment and what to expect during the diagnostic process.
Getting a diagnosis toolkit. Alzheimer Society of Canada. Use this toolkit to help you prepare for a conversation with your doctor or healthcare provider about your concerns and questions about a possible dementia diagnosis.
Evaluating memory and thinking problems: What to expect. Alzheimer's Association. This interactive webpage is a fun, visual way to understand what to expect while getting your diagnosis. The information on this page is also included in a downloadable, print-friendly PDF.