How is dementia diagnosed?

Naturally forgetful people forget where they put their keys. People with dementia forget what keys are for. Naturally forgetful people say, "Dang! Where did I put my sunglasses?" People with dementia say, "Someone snuck in and stole my sunglasses!" I knew something was very wrong when my husband couldn't remember how to make tea from the tea bag and pot of water the waitress brought him.

It is not so much just the frequency of forgetting as the nature of what is forgotten and their reaction to it.

Dementia has other components in addition to memory loss. (Different kinds of dementia have different characteristics.) These may include hallucinations, delusions, paranoia, problems with depth perception, sleep disturbances, difficulty in coming up with even obvious solutions, anxiety over decision making, loss of sense of smell, and many more.

If grandmother develops additional symptoms that could be dementia, it may be time to get her evaluated.

For now, you know what grandmother's behavior is like. Whether you have a label for it or not, it is what it is and it is what you have to deal with. There are no cures for dementia and very little in the way of treatment plans.

In what way do you think having a diagnosis would change things for you?

There's no concrete diagnosis. It's not like a virus or bacterial they can identify. There's no medical test for dementia. It's basically a diagnosis based on behavior.

Our doctor says dementia is a condition that typically displays itself in loss of memory and changes in behavior - in general, the loss of memory results in changes in behavior. Lapses of memory as in - where car keys or glasses are - happen to everybody sooner or later and seem to increase as we age WITHOUT being dementia. And, there's loss of short-term memory vs loss of memory of most of the past. You'll find that a lot of older people will be able to talk knowledgeably of the past recalling names, dates, places, old addresses - but don't know what they had for lunch. A friend, for whom I advocate, has short-term memory loss - yet she DOES remember some current or recent history. I've tried to figure out what about the things she DOES remember might have made the difference, but there's seemingly no common denominator. She knows what I gave her for Christmas, mentions it often; but probably won't know the next day that we went out to eat the evening before. So, what she remembers doesn't seem to be related to whether it was a pleasant or bad experience. I can say this: she clearly reacts badly to the word "dementia," relating it, I think, to "demented" which conjures up the picture of an insane asylum in the 1800s that we've seen in movies. She is not nearly so fearful of the idea of "memory loss." There are just soooooooooo many variations.

I have found that Teepa Snow has some wonderful information and videos on dementia and resources to. Just Google her name and you will find every thing you need.

For my mom she was given cognitive tests, multiple ones. These are repeated each time she goes to the doctor. They are simple simple things like can you draw the face of a clock, or a box, do simple math, follow directions, remember words, etc.. She was also given thorough physical exams, mri, and blood work plus a sleep study. All these things plus her symptoms of odd behavior, anxiety, sleepwalking, delusions helped make the diagnosis. Forgetfulness is just the beginning.

Cognitive memory tests are not a diagnositic tool, only an MRI can actually show if there is any Dementia or Alheimers. PTSD has the same symptoms as both Dementia and Alheimers, PTSD can happen at an early age though and is caused by Trauma and Stress. as well you always want to try to keep their memory from getting any worse and that is by making sure they eat healthy, keep the brain active. the best thing is to read. help them to remember a clock .. the memory is basis'd on repetition.

Rather than asking how dementia has been diagnosed, if you're talking about a particular person, you might do better to ask whoever you're talking to "please be specific."

I think at the last count we're up to a few dozen, is it? types of disease which will result in dementia, definitively, as in: "loss of one's mind." Bearing in mind that even the word "mind" covers a multitude of concepts - memory, language, spatial awareness, sense of self and one's surroundings, decision-making, responses to stimuli, adherence to social norms... everything your brain does.

Some people say dementia when they mean Alzheimer's Disease, and vice versa. Some people casually use the word demented when they mean hyper-stressed or very angry. If the subject matters enough in a particular context, you just have to nail down a more accurate and detailed description of what is going on.

In my mother's situation cognitive testing was done (questioning simple things like who the current president is), both an EEG and an MRI was done. This was done after 4-6 minor car accidents, extreme forgetfulness (several times a week she was having house and car keys made only to find the originals in her purse, couldn't find where she parked her car, etc). Her temperament went from irritated to hostile with everyone. She was going to the bank 3x every week to see that her act was balanced. These are some issues I saw along with the testing/diagnosis that determined Dementia/Alzheimer's, there was significant damage to blood vessels (determined by MRI) to come up with the 95% diagnosis. Her Dr said 100% diagnosis could only be done with an autopsy due to insurance not covering a very expensive test. These are some characteristics I've found and information I've learned, I hope this is of some help, my best advise is be there, be supportive of your loved one, HUGS to all going through this.

I would find a doctor who is familiar with dementia and knows more than an average doctor about it. The reason, is that some doctors aren't that up on the condition, imo. The doctor then, can evaluate your LO and help with questions. They can refer you to a neurologist if needed. Also, I'd check out the Teepa Snow videos as mentioned above and read sites online.

From my experience, cognitive decline and/or dementia doesn't always initially present itself with memory problems. What I observed was more in the line of POOR judgment, apathy and agitation. I couldn't figure out why my LO wouldn't do things that they would have in the past, like wash hands before handling food? Why would they insist on wearing diapers, when they were perfectly capable of going to the bathroom? Why would they be so cross and disagreeable, for no reason? I struggled with this and even questioned health care workers, who said the patient was lazy and spoiled. But, they were wrong. It was dementia in the early stages. Later, it became clear what was happening.

During this time, someone asked me about dementia and I said, NO way, her memory is fine. But, then the memory went too. Even though I had seen the odd behavior, I was still shocked when her GP diagnosed with dementia in an office visit with a Mini Eval.

So, I'd make a list of your observations and discuss with a professional who will be familiar with symptoms and able to order appropriate tests, if that is what you feel you need. When dementia is obvious, some people, don't get further tests to determine why and more details. I did have further tests with a neurologist with my LO and it confirmed the GP's diagnosis of Vascular Dementia, but, my LO was so young (62), I felt that further testing was appropriate.

I hope you can find the answers you are looking for.

When she forgets who you are & what your name is....or starts to hit you, asking for her parents & where they are, asking to go home & she is in her house....a brain MRI can reveal more info

My dad had a brain scan when he was admitted to the hospital for a range of medical problems, I was informed that the shrinkage in the brain indicates dementia, what kind, what stage, who knows but, it is going on 9 months since "diagnosis " and I see decline on a weekly basis. I am in a similar situation as you, is this the disease or game playing. I know how frustrated you must feel and the unknown of it is so very trying. I made the decision that anything other then obvious truth and reality will be treated as the disease, it is the only way I can cope. I just figure if he wants to play dumb, for whatever reason, he can deal with the consequences of that or he can stop with the mind games. So far I am able to visit without a meltdown afterwards. Ugh, truth or game. This has always been his way so it can drive me crazy trying to sort it out, hence the above solution. God bless you on this journey, it gets more challenging so keep a sense of humor and find coping mechanisms that keep you sane🤡👍

There is a verbal test that is performed at DH's annual examination. It is mainly a "problem-solving" test. Out of 30 points, he scored 25. So he doesn't have Dementia but he does exhibit sundowners.

Once Dementia is diagnosed, there is a PET scan to determine if Alzheimers.

HOWEVER, with my DH, I researched and started giving him a drop of Food Grade Iodine, 150 mcg (minimum daily requirement), in his first cup of supplement and his cognition has really turned around! After months of not knowing me as his wife, he now knows me and knows that we are in our own home. And he knows where the bathroom is again! Yes, you can and should ask your physician - but mine didn't think it necessary but when I determined it wouldn't hurt him, I started the Iodine Therapy and never looked back.

OMG! It's like a miracle!!

So along these lines I noticed over the past several months that my husband is a bit “off” in his memory. A recent example was our son and his girlfriend walking through the room as we were watching TV saying they were leaving and would be back later. Just after the door closed husband inquires “so are the kids downstairs?” Another thing I’ve noticed is his calling programs by the wrong name. We work different schedules and there are several Prime Time shows we both like. He will constantly call “How to Get Away with Murder”, “Murder She Wrote”. His recollection of events or conversations is usually different from mine and he asks the same questions several times. If the TV is on the rest of the world disappears to him. Should I be worried or am I oversensitive because his father had memory issues, but only after a stoke when he was in his 70’s, hubby just turned 60 in September.

This is an interesting subject. Just last night I went to hear Dr. Wint from the Lou Ruvo Cleveland Clinic for Brain Health in Las Vegas speak about memory loss. I was amazed by the number of medications that we can take that causes memory issues. Even over the counter if taken on a regular basis. Other things such as Chemo treatments or thyroid (over or under active) can cause memory problems. After listening to him, I agree with Sunnygirl1, that get with a doctor that can look at the total picture. Some medications taken is a good thing/bad thing. The medication is to help solve one problem of medical condition but it can also interfere with memory. All the other responses are also spot on on how Dementia is diagnosed. My point from what I learned is that there are many causes to memory and a Doctor who deals in Memory would be able to shed some light on the situation for proper diagnosis.

mejjy11;

Indeed there are many articles everywhere about Alzheimer's and dementia. First thing to understand is that the term "dementia" is an umbrella term in that it covers a multitude of conditions. From Wikipedia:

"Dementia is a broad category of brain diseases that cause a long-term and often gradual decrease in the ability to think and remember that is great enough to affect a person's daily functioning. Other common symptoms include emotional problems, problems with language, and a decrease in motivation. A person's consciousness is usually not affected. A dementia diagnosis requires a change from a person's usual mental functioning and a greater decline than one would expect due to aging. These diseases also have a significant effect on a person's caregivers.

The most common type of dementia is Alzheimer's disease, which makes up 50% to 70% of cases. Other common types include vascular dementia (25%), Lewy body dementia (15%), and frontotemporal dementia. Less common causes include normal pressure hydrocephalus, Parkinson's disease, syphilis, and Creutzfeldt–Jakob disease among others. More than one type of dementia may exist in the same person."

...and under the Signs and Symptoms:

"The symptoms of dementia vary across types and stages of the diagnosis. The most common affected areas include memory, visual-spatial, language, attention and problem solving. Most types of dementia are slow and progressive. By the time the person shows signs of the disorder, the process in the brain has been happening for a long time."

For the most part, Alzheimer's cannot be determined 100% until after death (autopsy.) Several other dementia related conditions have much different progressions (and it does not sound like your grandmother would fall under those, such as Parkinson's, Lewy body, frototemporal.)

When you say "They never give examples of anything and every case is different.", we can tell you yes, every case IS different. Just like every person is different, how the underlying condition manifests and it's progression will be different, HOWEVER, there are common signs that do show up in most people afflicted. Those signs can be different for each underlying cause (please see https://en.wikipedia.org/wiki/Dementia - it lists the various causes, signs and symptoms, progression, and a lot of useful information.)

If you do read the Wikipedia page listed above, it does describe the stages and what one might expect to observe. Again, not everyone follows the script verbatim. The early stages might not even be noticeable to anyone. My brothers did not catch on because they did not talk to/see mom as often as I would. In her case, the obvious sign was repeating herself, questions and/or comments. It was subtle and started slow, but gradually became SO annoying, until you realize what it is and work around it. However, being with someone all the time can also hamper the observation of these subtle changes (like someone can gradually gain or lose a lot of weight, and you don't observe it because it IS so gradual and you see the person every day, whereas someone who has not seen the person in months will immediately notice the change!) That initial level and even other levels can follow a very slow progression - again it depends on the person. Our mother started this several years ago, and as the article notes, sometimes in retrospect some things she said and did can be put into perspective now (falsely accusing others of taking items, losing/finding items, etc, using an alternate, not-quite-right word for something.) She lived alone, so we started with cameras to check on her or visitors. The inability to properly take care of finances, making errors or paying something late or twice became apparent next and I took this over. We brought in health aides (they had a nurse do the test first) 1 hour/day, which only lasted a few months before she refused to let them in. The repetition of statements and questions became even more pronounced (at this stage, my brothers and nieces were asking what is wrong?) Another thing to note is that some people in the earlier stages can "perform" better when needed (with visitor's, at the doctor's, etc.) This is referred to as "show-timers" and can present the person as being almost normal - this charade cannot be kept up for too long. So, just taking her to the doctor and having him/her check for any signs can yield negative results, when in the earlier stages. A doctor is less likely to know what is normal for this person as he/she sees them so infrequently. After we moved our mother to MC, even more signs became obvious back at the condo. I knew she was eating too many frozen dinners. She used to prepare her food for lunch and dinner, but the freezer was full of unused chicken, vegetables, etc. Fresh vegetables all dried up or moldy in the fridge. Muffins wrapped up but not eaten (some wrapped in torn up grocery bags, despite having excess plastic wrap and baggies!) SO much stuff! Multiples of some items because she would forget she had it and buy more or ask us to get more. No more prep of snack items, eat things that come in a box or bag ready-to-eat (yes, some normal people do this, but this was NOT normal for mom and she was not just being lazy - at this point she could not follow a recipe.) On camera, also starting slow and irregular, was evidence of "sun-downing". It eventually became a nightly marathon, lasting one to one and one half hours before bed, checking the door lock, sidelights (often sneaking up on them, so to speak, as if she expected to see the boogieman out there!), dishwasher, out to the LR and repeat, over and over. I might recheck my lights or sliding door lock, but that is NORMAL, especially where the light switch is not on the path after coming in the slider and often the slider isn't quite latched! Checking it over and over for an hour plus is NOT normal.

To your statement about how everyone forgets things - yes we do. Brain farts is the term I have heard used for these occurrences. It can become more common as you age, but it is NOT dementia. Forgetting where you left your keys (or some other object.) - check! Going through a doorway to do or get something and forgetting why you went there - check! That last one, I read an article about this once that said there is something in the brain that switches when you cross a threshold, which can result in this lapse. I thought it was hogwash, but too often on crossing back over that threshold, the task at hand is retrieved magically! Can't recall the name of that movie, actor, song title - check, check AND check! But eventually, especially if you can forget about it, it will come back to you. With dementia, probably not. Someone's description of things like forgetting where you left your keys vs forgetting what the key is for (or alternately putting that item in an unusual place, like the freezer), that latter would be a later stage of dementia, not the mild or early stages.

Mom was NOT agreeable to moving, but we could not leave her alone. As it is, days before she was to move she injured her leg and developed cellulitis (nothing to do with cellulite - this can kill!) She did not even have enough sense to get it looked at or tell one of us, yet she would call 911 in a heartbeat and get an ambulance ride to the ER if she had a UTI before this stage. She moved into MC January 2017. It took about 9+/- months of asking when she can go back to the condo before that changed to asking for me to drop her off at her mother's (gone about 40 years) or if I had a key to a place she lived over 23 years ago. This is also part of the progression, however there is NO TIME TABLE. Everyone goes down the yellow brick road at their own pace. Some take detours, others never experience some of it, but in general at least vascular and ALZ go this way (again, best to read the Wiki page or go to Alzheimer's website: alz.org, or find more info on this site, as others have suggested.) In mom's case, she still does most ADLs: gets up, cleans up, dresses and toilets fine, goes to bed okay. She cannot cook and repeats herself all the time, and is starting to live somewhat further back in the past. Like someone else said, in most cases the person might not be able to tell you what they had for lunch 10 minutes ago, but a FEW things tend to stand out. In mom's case, I had to take her twice to the dermatologist to treat a basal cell spot on her face. When I check her face, or she sees the recheck appointment on the calendar, she asks why, I thought they already took care of this? Yet at Christmas dinner, she must have said 15 times that we just made it in time for dinner (another resident at the table was baffled, and told her she already said that!) I have observed many of the other residents and you can see how differently this impacts everyone there. Similarities, often yes. Differences? Absolutely. Some of the other causes are even more pronounced in differences (again, see the Wiki page.)

I did read somewhere that cancer treatments can have an impact, so that might play into it. It is hard to tell from your post how long ago that treatment was and how it might have affected her since then. On the other hand, your description of her sounds like perhaps this is just the way she is/was? Or perhaps it is a combination of the two. You did not specify an age, and there ARE age related declines that could be factored in as well, without it being any form of dementia. It could be something completely unrelated that has been there all along. Your examples are not specific enough to suggest what it might be or ways to "test" her - for instance if she is always asking you to find something for her, prompt her with places to look. Don't do it right away (or depending on how important the items is, not at all) and see what happens. More detail would be helpful and explain to us how today's behaviors are different from years ago for her. In the meantime, the resources I and others have provided might help you decide if it might be dementia or not.

Are you still here, mejjy11? Has anything we've said helped you?

Cognitive disorders (the correct term for what we used to call "dementia") are diagnosable. You need to begin with a neurologist (who will order, among other things, an MRI) and then move on to a neuropsychologist. The testing done by the neuropsychologist is very sophisticated. There is a huge difference between the normal forgetfulness mentioned in some responses and a cognitive disorder. The people who discuss these are right. Don't ignore your grandmother's problems -- some of them are treatable and how you and her care providers deal with her should be based on actual data, not assumptions.

A dementia patient's mind is going to be sometimes so "off" that it's almost bizarre. Example: My late, 94-year old mother had a friend who was a bit older than she. My mother's friend's name was "T." My mother said "T's bleeding internally." I said "Now, mother, if T were bleeding internally, she would be dead. Does that sound right to you that T's bleeding internally? No, it cannot be true." My mother's response="T's bleeding internally." UGH! There is no reasoning with an elder who has dementia.

Just reviewed the replies (always in search of something that might help my friend), and agree generally that Dementia is characterized as memory loss and changes in behavior. I was remiss in not relating the whole experience of diagnosis. My friend's doctor did perform a quick cognitive test - remember 3 words - which my friend failed to retrieve from memory 5 minutes later. He also sent her for a battery of blood and medical and physical tests to ascertain that there were not other potential causes. There are situations were the lack of an enzyme or essential vitamin or mineral cause memory loss, so it is important to rule out other potential causes.

Sassy75 - to your comments "I can say this: she clearly reacts badly to the word "dementia," relating it, I think, to "demented" which conjures up the picture of an insane asylum in the 1800s that we've seen in movies. She is not nearly so fearful of the idea of "memory loss."":
This reminded me of what our mother did/said. She would very often, early on, say she doesn't remember something, she forgets, but she's entitled because she is old. Um, yeah... as noted, we do all forget things, but in her case it was more than that, she was forgetting that she forgot stuff! You just couldn't tell her that. Also, early in her MC stay (she was first, several more started shortly after), she read an article in a local paper written by the daughter of a new resident. She loves to read, but in this case it was not a wise choice to leave that paper out for them! There was a picture included of the mother and daughter and mom recognized the mother. So, dear old momsy says to this woman - your kids put you here because you are off your rocker! She also relates the word "dementia" with that connotation. The funny part is she was not able to figure out that since you are also here, you must be 'demented' too! I was horrified to find out she had done this, and just hoped that the other woman would forget it was said, if she even realized what my mother said, and certainly hope the daughter never heard about it! She always has been quick to criticize others, but never sees the same in herself... :-/ At Christmas, she was pointing out another resident's daughter and saying how big she was... my thoughts were 'mom, you need to go look in the mirror!' They had recently asked me to get her some larger undergarments and clothes as she has gained weight (and was no skinny minny before that!)

There is a school of thought that it's better (easier) not to confront or correct the Dementia patient's beliefs or behaviors; but I think it's a situational judgement call. Sometimes, it's just not worth the effort - but, in the case of my friend, I've learned that putting a name to the fears she expresses can make her feel better. It's confusing enough to wake up in a new world daily, but then to have those they trust act not acknowledge that there is a problem can add to confusion and make trust an issue. My friend KNOWS there is something wrong - so she actually responds with relief when I explain (almost every time that I see her) that her feelings are a result of memory loss - and that I would feel the same if it was happening to me. But, it is a daily judgement call on my part. I've learned that acknowledging and offering an explanation for how she feels works better in the morning - giving her "information" that helps her understand things that happen during the day; while not acknowledging it in the evening saves her from worrying about it as the day ends. Either way, if she did not respond well to my being truthful with her, I would not continue to answer honestly. It's a judgement thing about what makes her more comfortable, not what helps me deal with her anxiety.

Let me get back to the story of my late mother and her still living friend T (her real name is Thyra, which she doesn't use). T will turn 102 years of age on February 27, 2018!! This incredible woman who lives only yards away from my mother's Massachusetts home and whom I would visit 10-17 times when I had to live with my mother-bringing her home baked goodies and the like, but mainly for a well being check. I keep in communication with T through the telephone after my mother died. T actually said many times after each conversation I would have with her "You know, Nancy, you'll have to tell me this all over again because I will have forgotten what you've said." I thought to myself that T is a genius; not only is she legally blind, but she has the wherewithal to know that her brain is failing her!

Someone said that if you regularly can't find your keys at 25 why should you suddenly be able to find them at 75 - but if you can't find them & they are in the jacket pocket you wore yesterday that's forgetfulness but if they are in the freezer & you are doing similar things then that's something else that needs investigation by a medical specialist - it has to be looked in context

Also if it is a sudden change then look at UTI as the culprit not dementia - this doesn't mean there is no dementia but that the quick change is due to the UTI & try to remember that some of the acting out is the result of confusion in their mind which leads to fear which leads to anger which leads to the acting out much like a domino effect - much like taking a med that makes you woolly headed & you know something is off but these are done without meds rather from within - I hope this is clear

This is slightly off topic---but then again maybe not.
When my DIL was in MEd School DH and I had flown out to CT to visit the "kids". We were both seriously jet-lagged from the redeye flight and exhausted--the kids had slept all night and were full of energy. We wanted to go to sleep, DIL said "Come for a drive, we'll show you New Haven and I can practice my dementia testing on two people I KNOW don't have dementia!" Ok, we go for the ride and we are so both exhausted that we failed, and failed EPICALLY the "verbal" dementia test. We didn't know what county we were in, we weren't sure what the date was, we didn't know the name of the mayor or governor or what "our" address what.

My DIL got a real kick out of that. I've never forgotten the completely "lost" feeling I had. I truly DIDN'T know a lot of the answers, as I didn't live in CT and had actually never been there before, but due to being so tired, I wasn't even sure who the President was. Made me a lot more sensitive to my parents as they went down that slope. It's very frustrating--esp when you know you know something, but can't drag it out of the recesses of your mind. I imagine real dementia feels like that.

I think that is very perceptive, Midkid. Thanks for sharing!

Well I don’t think your dad is playing games my mother was diagnosed with vascular dementia 2014 and there are times I thought she was experiencing Showtime that means they know how to act just like nothings wrong with them but has today of 2018 I watch my mother go in and out herself meaning she’s mother holding conversations and Caring on, all laughing and giggling together. She needs assistance with ADL for herself but she does feed her self with her fingers and she can let you know when she needs the bathroom /she wears Incontinents today mother was a child behavior for two hours very juvenile so she’s gonna sit on the floor and have a hissy fit Tearing plastic bags after that she asked for help off the floor came into the kitchen and we had a very decent conversation of what we were going to do tomorrow . I asked her why she was on floor and she responded no no not me .So I’m sorry you don’t know what type of dementia your father has. you need to know in order to assist his needs better. So I’m getting my mother further evaluated with the neurologist this Friday because I need to know where she’s at and has her brain also is deteriorating more from the left side and she does have multi seizures/ trimmers daily more often and this to do major damage .
I strongly dislike this disease: no cure . I personally know what my life back tired on her journey. It’s not that easy .

I forgot yes she had blood work completed all good . Mmm
She schedule for CT & EEG . Approval for CT cleared hopefully before Friday Insurance will approval EEG
Again might have to admit her to hospital to get this completed. Because I don’t know 🤷‍♂️ whom / behavior she might be that day . It’s always wait and see . GB

Midkid - so perceptive & timely about even jet lag can mimic dementia - we will all try to remember your experience when dealing with our loved ones who have it - for those who never have had jet lag ... YOU'RE OUT! ... DO TO LACK OF EXPERIENCE - if you have never gone beyond the same place you will never understand

moecam: I get your point about misplacing keys, though a person of 25 years of age SHOULDN'T misplace them. I think that you were just trying to make an analogy.

Sassy75: Yes, as you said, there are two schools of thought involving correcting a person with dementia who errs in verbal statements or their actions. It gets EXTREMELY tedious to tell the person "I already told you that that's wrong," for example. Should you correct them? I say only when it absolutely is going to cause them bodily harm, i.e. my late mother had this rather strange habit of keeping a loaf of bread in her microwave. Well, guess what that loaf of bread is fastened with? That's right-a twist tie that contains metal. SO after my husband and I had just bought her a brand-new microwave after the push button on her old one broke, we come and find a scorch mark on the new microwave. "Ahh, okay, mom, when were you going to tell us that you started a fire in your microwave?" She wasn't! We had to stumble upon it ourselves!
Otherwise telling the dementia person, i. e. "You already told me that"-you may as well be talking to the wall!