Health care - Assessment and testing - Process

The diagnosis is mainly clinical, and no single test can provide an accurate conclusion. In fact, the diagnosis is mainly dependent on the kinds of symptoms presented, supported by the results of memory and thinking tests, laboratory, and possibly imaging tests. Unlike other diseases, such as hypertension or diabetes, where there is an objective test for diagnosis, an accurate dementia diagnosis requires interpretation of many pieces of information. There are persons who score within "normal" limits of memory and thinking tests and have dementia, and others who score abnormally and do not have dementia. Clinicians will also take a thorough history of the symptoms that may include talking to a family member who may provide helpful information. For example, family members may be asked what the individual can do for him/herself, and what activities the family member had to assist with or take over, and why?

Source: The information above comes from the Murray Alzheimer Research and Education Program (MAREP). (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

It takes time to make a diagnosis. Several tests should be conducted to rule out other problems that may be contributing to your symptoms or the symptoms of your family member. Normally, the process will include:

• A visit to your family doctor
• A physical examination
• Initial diagnostic testing
• Detailed medical and medication history (including a detailed review of all current prescriptions, over the counter medications, vitamins, and herbal products)
• Memory and skills tests such as the Clock-drawing Test, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA)
• Mood and emotional assessment
• X-rays and possible imaging studies such as Computerized Tomography (CT) scans, if necessary
• A visit to a specialist such as a neurologist, psychiatrist, geriatrician or family physician with training in memory disorders

Source: The information above comes from the Murray Alzheimer Research and Education Program (MAREP). (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

There are potentially several causes of memory or thinking problems, some of which can be easily fixed. These could include other medical conditions such as delirium, depression, metabolic causes, stroke, adverse drug effects, and other conditions. Additionally, different tests examine different parts of brain functioning. It is necessary to do a thorough and comprehensive assessment in order to produce an accurate diagnosis.

Source: The information above comes from the Murray Alzheimer Research and Education Program (MAREP). (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

Due to the number of tests that are required, the assessment and testing process may be lengthy; however, the time it takes to receive a diagnosis varies widely. The time testing takes depends on what tests are administered and where the tests are conducted such as at your family doctor’s office, at a memory clinic (a clinic that operates within a health care centre, and provides routine outpatient care), or a health care centre that has highly trained specialists and advanced technology. 

Some family doctors may do brief screening tests which takes 10 to 20 minutes. The Montreal Cognitive Assessment (MoCA) usually takes 10 minutes. A large amount of additional time, however, is spent on taking a detailed medical history from the individual and from a family member. This could take a couple of hours and may also include a multidisciplinary assessment including a social work interview and a pharmacists' drug review. In other care settings, visits can take a half day and might include other types of assessments. It varies widely and it may take repeated visits before a diagnosis is made. It is important to note that no one test alone is adequate or acceptable in diagnosis dementia.

Source: The information above comes from:

Murray Alzheimer Research and Education Program (MAREP). (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

The Free Dictionary. (November 22, 201). Tertiary care. 

The testing and assessment process may provide the first opportunity to openly discuss the possibility of a diagnosis. It is important that assessment and testing not be delayed, as it prevents delay in establishing a diagnosis and options for treatment. Testing and a comprehensive evaluation leads to an accurate diagnosis and discussion of treatment, enabling greater control in your life by providing choices based on knowledge and understanding and opportunities to plan ahead.