When it comes to diagnosing dementia, there is no single test that can be done to determine if you are living with dementia. A combination of different tests and evaluations that your healthcare provider will conduct and order will help him, or her conclude if you or a loved one is living with dementia. Among the tests your healthcare provider will order will be a panel of laboratory tests.
After going through different sets of dementia testing, including medical history, physical exam, Neurological exam, Cognitive testing, brain imaging, and laboratory tests for dementia, your doctor will be able to determine if you are living with dementia.
What is Dementia?
Dementia is a term that is used when you are experiencing symptoms that affect your memory, communication, thinking, and judgment. There are several different types of dementia. These include but are not limited to Alzheimer’s Disease, Vascular Dementia, Lewy Body Dementia, and Frontotemporal Dementia.
The symptoms of dementia vary based on the type of dementia that you are living with but may include the following:
- Memory impairment
- Asking questions multiple times
- More confusion than normal
- Anxiety
- Changes in mood and personality
- Behavior issues
- Trouble sleeping
Many factors can increase one’s risk for dementia.
- Brain cells and neurons die over time, causing damage to the brain.
- Trauma to the brain. This can be from strokes, brain tumors, or head injuries.
- Depression
- Vitamin B12 or E deficient
- Thyroid issues
- Alcohol / Drug use
If you think you or a loved one may have dementia, it is important to make an appointment with your healthcare provider to discuss your symptoms and concerns. They will ask simple questions and run a series of tests to help determine what is causing your symptoms. You may be a good candidate for clinical trials and different treatment options that may help slow its progression. If you live with dementia, getting an early diagnosis will help you plan and prepare for the future.
Am I Living with Dementia?
You may find yourself wondering if you are living with dementia. If you find it more difficult to balance the checkbook, cook from a recipe, or learn a new game with the grandkids, you may wonder if this is aging or something else. You may also be asking yourself:
- Is something wrong with me?
- Do I have dementia? Is this normal aging?
- Do other people notice me struggling with these tasks?
What Are the Benefits of an Early Diagnosis of Dementia?
There are many benefits of an early diagnosis of dementia. Understanding these benefits may help you take steps to make an appointment with your doctor and see if you are living with dementia. These benefits include:
- Your healthcare provider will give you an accurate diagnosis based on testing and symptoms.
- You can be actively involved in decisions that affect you now and in the future.
- More effective treatment may be available.
- Focus your life on what is most important.
- Get your financial, legal, and medical matters in order.
- It gives you and your family time to understand the challenges ahead and prepare for them.
- Allows you to raise awareness of dementia.
What Will Happen at My Appointment with my Doctor?
When you meet with your doctor, it is good to take a loved one or very close friend with you. They can help you remember the details of your appointment and help you remember any questions that you would like to ask. Your doctor will run a series of tests and order lab tests and brain imaging tests.
#1. History
Your doctor will begin with a history of your symptoms and when they started. They will also review all your medications to ensure that they are not causing your memory impairment. They may also check to ensure that all your preexisting conditions are being taken care of and managed properly, such as heart disease, diabetes, depression, and stroke.
#2. Physical Exam
Your healthcare provider will do a physical exam while you are in the office. They may do the following:
- Ask about diet and lifestyle.
- Review medications. You want to be sure to bring all your medication bottles with you, including any that are over the counter or supplements.
- Check temperature, blood pressure, and pulse.
- Listen to your heart and lungs.
- Assess Overall health
- Order lab tests
#3. Cognitive Testing
You will then undergo cognitive testing to test things like thinking, memory, judgment, and language. A cognitive test alone may not be the only determining factor to test if you have dementia. Still, it will help determine if you have some level of cognitive impairment. Several different types of cognitive tests can be given. Some of these include:
- Montreal Cognitive Assessment
- Mini-mental state exam
- Mini-Cog
- GPCOG
Your healthcare provider may also ask your close friend or family member a series of questions to help understand the whole picture. These questions would come from one of the following tests:
- AD8
- GPCOG
- IQCODE
#4. Laboratory Tests for Dementia
Your healthcare provider will order a series of lab tests to help diagnose dementia and rule out other conditions that may be causing your memory impairment. Lab tests on their own will not determine if you are living with dementia.
What Lab Tests will my Doctor Order?
Your healthcare provider may review any current lab tests and order new tests. Your healthcare provider will order tests based on your medical history and certain blood work that is recommended for anyone who is experiencing memory loss and thinking impairments. Your healthcare provider may order the following:
#1. Complete Blood Count (CBC)
Your healthcare provider most likely will order a complete blood count. This test will measure your white blood cells, red blood cells, and platelets. It will also measure your Hemoglobin and hematocrit levels. This test will also look at your red blood cell’s size, color, and how their ability to carry oxygen.
- Interpretation
Abnormalities in your white blood cells will indicate that they may be an infection. Your red blood cells contain both hemoglobin and hematocrit, which help determine the quantity of the red blood cells and their function.
If levels are low, this may indicate that you are anemic, causing fatigue and difficulty thinking.
#2. Comprehensive Metabolic Panel
Your comprehensive metabolic panel test will measure your electrolyte levels (sodium, potassium, chloride, bicarbonate), glucose levels, kidney function, and liver function. There are some electrolyte or glucose abnormalities and kidney and liver abnormalities that can cause thinking and memory impairments.
- Interpretation
The liver function test will test how your liver is functioning. When your sodium levels are checked, it measures how much sodium is in your blood. Abnormal glucose levels can confuse if not treated. Your bicarbonate may show that you have alkaline or acidic, which several conditions may cause. High creatinine and blood urea nitrogen will show kidney impairment or dehydration.
#3. Thyroid Stimulating Hormone (TSH)
Thyroid Stimulating hormone will look for abnormalities in your thyroid. Whether your thyroid is overactive or underactive, it can cause impairments in thinking and your memory.
- Interpretation
If this test comes back abnormal, you may undergo more testing to confirm that your thyroid is not working properly. If you have high thyroid-stimulating hormone, then this indicates that you have hypothyroidism or an underactive thyroid. If you have low thyroid-stimulating hormone, then this indicates that you have hyperthyroidism or an overactive thyroid.
#4. Vitamin B12
It is common to be Vitamin B12 deficient, especially when you are aging. This can cause many symptoms that affect both cognitive and psychiatric. Suppose you are on the border of being B12 deficient. In that case, additional testing may be ordered that will indirectly measure the number of functional B12 in your system. If you have high Methylmalonic acid levels, this indicates that you are deficient in Vitamin B12.
- Interpretation
If you have low B12 levels, this will indicate that you are Vitamin B12 deficient. If you have high Methylmalonic acid levels, this is an indication that you are Vitamin B12 deficient.
#5. Rapid Plasma Reagin
Rapid Plasma Reagin is a screening test for syphilis, a sexually-transmitted infection. If this is left untreated, syphilis can infect your nervous system. This is called “neurosyphilis” and can cause dementia. While syphilis is rare nowadays, individuals may still get it. It is treatable with antibiotics, which is one of the main reasons your healthcare provider will still test for it.
- Interpretation
“Non-reactive” is considered a negative test and that you do not have syphilis.
“Reactive” is considered a positive test, and your healthcare provider will order more tests to confirm you have syphilis.
#6. Human Immunodeficiency Virus
If you have Human Immunodeficiency Virus or HIV, it can cause changes to your thinking or memory. The infection itself can cause these changes or because HIV is weakening the immune system.
- Interpretation
“Non-reactive” means that the test is negative and that Human Immunodeficiency Virus or HIV is not present.
“Reactive” means the test is positive and that Human Immunodeficiency Virus or HIV may be present, and further testing needs to be done.
How Do Lab Tests Help with my Diagnosis?
Certain lab tests that your healthcare provider can order can help evaluate if a treatable condition is causing your memory and thinking impairments.
Brain Imaging
Your healthcare provider may also order brain imaging once the other tests have ruled out other potential diagnoses that may be causing cognitive problems.
These brain tests cannot diagnose the problem, but they can contribute to your dementia diagnosis. Your healthcare provider may order one of the following:
- MRI scan
- CT scan
- SPECT scan
- PET scan
After all, these assessments are complete and your healthcare provider reviews your laboratory tests, they will determine if you have dementia or another disease or problem that is causing your cognitive issues. Once this is determined, your healthcare provider can help develop a treatment plan based on the conclusions.
References
- https://www.alz.org/professionals/health-systems-clinicians/cognitive-assessment
- http://gpcog.com.au/index/informant-interview
- https://mini-cog.com/mini-cog-instrument/standardized-mini-cog-instrument/
- https://medlineplus.gov/lab-tests/cognitive-testing/
- https://memory.ucsf.edu/sites/memory.ucsf.edu/files/wysiwyg/UCSF%20Dementia%20Patient%20Guide_Dementia%20Evaluation%20Lab%20Testing_11-3-17.pdf
- https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/diagnosis/laboratory-tests.html
- https://www.nhs.uk/conditions/dementia/diagnosis-tests/
- https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests
