If you or a loved one is having problems with your memory or other thinking skills (cognitive skills), the Sutter Health network of Alzheimer’s and brain health specialists can help you determine the cause of the problem. Alzheimer's disease and other types of dementia are defined as a loss of memory and other mental abilities severe enough to interfere with normal daily activities.
Alzheimer’s disease, while common in older people, is not the only cause of cognitive impairment. There are other forms of dementia, some of which are much milder than Alzheimer’s. There are also a number of unrelated medical issues that can cause symptoms that look like dementia. Getting an accurate diagnosis is the first step. At Mills-Peninsula Medical Center, we often partner with specialists at Palo Alto Medical Foundation for many of the services listed below.
The Diagnostic Process
No single test can determine if a person has Alzheimer’s disease. Our brain health specialists begin with a thorough history and review of your situation and then use a wide range of tools to assess cognitive function and rule out problems that can look like dementia, such as hearing loss and depression. They will also assess for physical issues, such as diabetes or high blood pressure, which can cause vascular changes in the brain and contribute to cognitive changes.
Medical Exam and Laboratory Tests
Your doctor may assess you for cardiovascular conditions such as high blood pressure and stroke, as well as for diabetes, infection, B-12 deficiency, and thyroid, liver and kidney issues. These and other conditions (including Parkinson’s disease, HIV infection, depression and infection) can cause cognitive problems that sometimes look like Alzheimer’s disease. Laboratory tests on blood and urine samples can help to identify or rule out many of these conditions. Brain imaging is also essential early on as part of a thorough diagnosis.
A neurological examination helps determine how well your nervous system is functioning. A doctor will carefully assess your personal history and perform a cognitive screen. The neurological examination assesses speech, strength, sensation, balance, coordination and movement. This involves fairly simple tasks such as moving your eyes, pulling or pushing the doctor's hand or walking a straight line.
A neuropsychological evaluation includes many parts. The first step involves gathering a comprehensive history using a psychosocial assessment. A psychosocial assessment helps your doctor understand more about your particular circumstances. You may be asked questions about your current living situation, work history, family history, emotional well-being, and social activities and hobbies.
The second step involves neuropsychological tests to evaluate how your brain’s health is affecting your behavior, your ability to carry out daily living tasks, and your ability to think, remember, solve problems, learn and reason. Most of these tests involve tasks such as remembering a list of items, drawing pictures, sorting items and naming objects in pictures. This helps your care team form a diagnosis and treatment recommendations.
Imaging Exams and Neurodiagnostics
Imaging scans of the brain can help your doctor diagnose some causes of cognitive impairment, such as a tumor, stroke, a neuro-degenerative process, head trauma and others. An MRI scan is usually the first choice of exam; other options are CT and PET scans.
Additional tests may include:
- Laboratory evaluations such as blood work.
- A sleep evaluation to identify problems such as sleep apnea or breathing problems that can affect cognitive function.
- A nutritional assessment to assess your diet and see where adjustments can be made that might boost your energy, improve strength, or lower your blood sugar, cholesterol or blood pressure levels.