Evaluation and Diagnostics
We adhere to nationally recognized standardized diagnostic criteria to establish a diagnosis and determine the severity of the condition. An evaluation will determine if the changes in thinking or memory observed are due to normal aging or the presence of disease and whether the condition is progressive and may worsen with time.
The evaluation also looks for contributions from other medical conditions and additional symptoms such as behavioral or sleep changes.
A typical diagnostic workup is a multi-step process and includes:
- History and neurological exam
- Laboratory tests
- Neuroimaging
- Neuropsychological evaluation
The evaluation is a four-step process which typically takes place over the course of two weeks. The goal of the evaluation is to provide a diagnosis which will, in turn, determine what course of treatment to take.
First, the patient and their family will have an initial visit with the neurologist to discuss their concerns. At the first visit, the neurologist will review previous medical records, take a clinical history, and conduct an interview of the patient in the presence of the family. Family members will be asked to provide information about the problems that have been observed. Most patients also have blood drawn at the conclusion of this visit.
Next, patients of the ADMDC are sent for imaging of the brain (i.e., CT, MRI, and/or PET), an electrocardiogram (i.e., heart monitoring to determine if the patient has had a heart attack or is experiencing abnormal heart function), and comprehensive neuropsychological testing. Your neurologist will determine which type of imaging test(s) is needed. Because the neuropsychological testing process takes an average of 3-4 hours, not including breaks for lunch, etc., this part of the evaluation occurs on a separate day following the initial visit. All diagnostic tests must be completed before the patient and family return for the follow-up visit.
At the follow-up visit, the patient and family meet with the neurologist to discuss the results of testing. A diagnosis will be made, and options for treatment will be discussed. Information on clinical trials or drug studies may also be provided. If it is determined that the patient requires additional testing or a referral to another provider, this will be arranged.
After the follow up visit, the patient and family meet our psychologist who will assess the patient's current living situation and provide counseling on issues relevant to the management of the patient's condition. Topics covered may include safety practices (medication management, finances, driving, supervision), involvement in stimulating and structured activities, socialization, and relevant legal issues.
See Patient Care and Counseling for more information on counseling.
Diagnostic Limitations for Alzheimer's Disease
While it is true that the presence of Alzheimer's disease can only be confirmed through autopsy or brain biopsy, a diagnosis can be made with greater than 90 percent accuracy when a complete workup is done, and nationally recognized, standardized diagnostic criteria are applied. It is important to realize there is no single lab test for AD. Similarly, having a brain scan alone will not determine if someone has AD because there may be no visible changes in the brain early on in the course of the disease, or the brain may show normal age-related changes or changes due to the presence of another type of dementia. A brain scan will tell your neurologist if the patient has had an injury or neurological event such as a stroke, but it cannot rule out the presence of Alzheimer's disease.
Monitoring, Treatment and Care
Our patients and family members receive the support of a multidisciplinary team over the course of their illness. Similar to diabetes or heart disease, Alzheimer's disease and other progressive dementias are chronic health conditions which require periodic reassessment and routine monitoring to ensure proper treatment.
Our patients are seen at least yearly for a complete checkup, including a full neuropsychological assessment to determine their response to treatment and degree of stabilization or progression.
Because we follow our patients closely and for such a long period of time, we are able to address the changing needs of both the patient and those who care for him.