Doctors use a variety of questions and tests to evaluate a patient for dementia. The initial questions focus on the patient’s medical history, family history, and a description of symptoms from the patient and caregiver. Doctors need this information to determine if symptoms truly indicate dementia versus another condition. As the evaluation continues, doctors will use cognitive tests to assess memory, reasoning, and communication skills. The full dementia evaluation aims to identify the cause and stage of dementia so appropriate treatment can begin.
Medical History Questions
During a medical history, the doctor will ask about the onset and progression of symptoms. This helps identify when problems with memory and thinking began. The doctor will ask about specific symptoms like:
- Memory loss – Forgetting recently learned information or important dates and events
- Difficulty completing familiar tasks – Problems driving to a familiar location or remembering rules of a game
- Disorientation – Getting lost in a familiar place or misplacing household objects
- Changes in mood – Depression, anxiety, increased irritation
- Changes in personality – Increased stubbornness, less empathy
- Loss of initiative – Less interest in hobbies, events, socializing
- Difficulty finding the right words – Vague language, long pauses in speech
- Problems understanding visual information – Difficulty reading, judging distance, recognizing faces
Along with the symptoms, the doctor will ask how quickly these changes happened. Gradual symptoms over several years point more to Alzheimer’s disease while a rapid decline over weeks or months may indicate a stroke or other issue. Doctors also need to know if symptoms are impacting the person’s ability to function at work, home, and in social settings.
Past Medical History
The medical history also looks at past conditions, illnesses, injuries, surgeries, medications, and supplements. Dementia can sometimes result from past head trauma, vascular disease, tumors, certain medications, vitamin deficiencies, thyroid disorders, heavy alcohol use, or other medical conditions.
Family History
Doctors will ask about any family history of dementia or related conditions like:
- Alzheimer’s disease
- Parkinson’s disease
- Lewy body dementia
- Frontotemporal dementia
- Huntington’s disease
- Down syndrome
A family history of these can increase dementia risk. For example, those with a first-degree relative with Alzheimer’s have a higher chance of developing the disease.
Cognitive Testing
After the medical history, doctors perform exams and tests to assess mental function. These identify problems in specific areas like memory, language, attention, reasoning, and visual perception. Performance on these tests indicates whether dementia symptoms are actually present.
Memory Tests
Doctors often start with simple questions to test memory:
- “What year is it right now?”
- “About what time is it?”
- “Can you remember the three words I told you a few minutes ago?”
As testing advances, they may ask the patient to:
- Repeat lists of words, numbers, or names.
- Recall details about a paragraph or story read aloud.
- Remember instructions for how to complete a task like making a peanut butter sandwich or creating an origami figure.
- Identify pictures of objects after a delay.
- Remember information over longer periods, like recalling details about a special event from years ago.
These tests reveal short and long-term memory function.
Language Tests
Doctors look for problems with language by asking questions like:
- “Please describe your breakfast this morning.”
- “Explain how you would plant a garden.”
- “Name as many animals as you can in one minute.”
They may also ask the patient to:
- Name objects in pictures.
- Repeat phrases and sentences.
- Take words that start with a certain letter and make new words.
- Explain the meanings of words.
- Categorize related words and explain how they are similar.
Difficulty coming up with words, using appropriate grammar, or explaining meanings indicates problems with language.
Attention Tests
Doctors assess attention span and concentration by having patients:
- Count down from 100 by sevens.
- Spell words backward or in reverse order.
- Find similarities between related words.
- Listen to a list of letters or numbers and then repeat them back in a specific order.
Inability to focus for long periods indicates issues with attention.
Reasoning Tests
Reasoning ability shows whether patients can use logic to:
- Find patterns.
- Make inferences.
- Interpret proverbs.
- Compare related objects.
- Offer solutions to problems.
Doctors may ask questions like:
- “Please explain what the phrase ‘the early bird catches the worm’ means.”
- “Here are pictures of a bicycle and a motorcycle. How are they alike and how are they different?”
- “If you see a stop sign at an intersection, what does that tell a driver to do?”
Poor reasoning ability indicates issues with high-level cognition.
Visual Spatial Tests
Doctors look for visual perception and spatial orientation problems by asking patients to:
- Copy a diagram of two intersecting shapes.
- Draw a clock face showing a certain time.
- Arrange colored blocks to match a model.
- Identify which abstract figures are the same versus different.
- Place numbers on a blank clock face.
- Copy a 3D cube diagram.
Difficulty recreating shapes, patterns, and designs indicates visual spatial deficits.
Physical and Neurological Examination
Along with the cognitive testing, doctors perform a physical exam, and may do a neurological exam testing reflexes, coordination, balance, and nerve function. This helps identify other factors that could be contributing to dementia symptoms like:
- Vitamin deficiencies
- Thyroid problems
- Stroke
- Parkinson’s disease
- Brain tumors
- Hydrocephalus
- Chronic infections
- Reactions to medications
Identifying these issues can help determine an accurate dementia diagnosis.
Mental Status and Neuropsychological Testing
If initial results are unclear, doctors may conduct more rigorous mental status and neuropsychological testing over several hours. This uses standardized assessments to systematically measure:
- Attention and concentration
- Speech and language
- Reasoning and judgment
- Memory
- Visual spatial function
Performance is compared to established norms to help pinpoint degree and type of impairment. This can identify specific dementia disorders like Alzheimer’s disease, Lewy body dementia, or frontotemporal dementia.
Conclusion
Doctors use a variety of targeted questions and assessments when evaluating for possible dementia. The medical history looks for common symptoms, associated conditions, and family history that could indicate dementia risk. During cognitive testing, doctors measure mental skills like memory, language, attention, reasoning, and visual perception. Significant impairment on several tests indicates problems with brain function that require further evaluation. Physical and neurological exams identify other possible causes of symptoms. More comprehensive neuropsychological testing precisely defines deficits that can identify dementia disorders. The full dementia workup aims to discover the underlying cause so appropriate treatment can begin.
| Medical History Questions | Purpose |
|---|---|
| When did you first notice memory problems or other symptoms? | Identifies onset of symptoms |
| What specific kinds of memory problems are you experiencing? | Clarifies if symptoms match dementia |
| Are you having problems completing familiar tasks? | Checks for functional declines |
| Has your personality or mood changed recently? | Looks for dementia-related changes |
| What medical conditions have you had in the past? | Identifies conditions linked to dementia |
| Is there a family history of dementia or related diseases? | Assesses genetic risk factors |
| Cognitive Test | Checks for Problems With |
|---|---|
| Recall details about a news story | Short-term memory |
| Remember childhood birthday parties | Long-term memory |
| Name objects in pictures | Language |
| Count backwards from 100 | Attention |
| Analyze proverbs | Reasoning |
| Draw a clock face | Visual spatial skills |
Primary Dementia Causes
| Type | Description |
|---|---|
| Alzheimer’s disease | Most common form, causes memory loss and cognitive decline |
| Vascular dementia | Caused by damage to blood vessels in the brain |
| Lewy body dementia | Abnormal protein deposits cause changes in thinking, movement, behavior |
| Frontotemporal dementia | Damage to brain’s frontal and temporal lobes leads to behavior and language problems |
| Mixed dementia | Alzheimer’s disease and vascular dementia occurring together |