When you start to notice possible signs of dementia in yourself or a loved one, it can be confusing and disorienting. It’s common to question whether the changes that you notice are simply due to normal aging. There are definitely some changes in our thinking abilities that happen as we age, but it takes a professional (or a team of professionals) to truly determine whether there may be signs of dementia. The process of getting an accurate diagnosis of dementia can be confusing, so in this post, we will break down the usual process.

Start with Your Regular Doctor

Typically, the process of diagnosing dementia stats with your regular doctor, or general practitioner. If you see this doctor on a regular basis, they are going to be the most familiar with your situation and they may have some perspective on changes that they have seen in you over time. Your doctor will probably want to run a few basic tests such as blood work to make sure there are not any obvious issues such as severe vitamin deficiencies that are causing memory loss or other thinking difficulties.

Typically, a general practitioner will not be able to give a diagnosis of dementia. The exception to this is when someone’s situation is clearly so severe that it does not require comprehensive evaluation. These would be cases of people who have obvious cognitive difficulties and are no longer functional in daily life, which requires them to be dependent on others for care. Aside from these plainly clear cases, a general practitioner will simply start the process and then refer you off to a more specialized doctor to investigate the situation further.

Neurologists are Brain Doctors

After your general practitioner, the most common referral will be to a neurologist. A neurologist is a medical doctor that primarily focuses on disorders of the brain or central nervous system. So they might work with people who have disorders like Parkinson’s disease, multiple sclerosis, migraines, brain injuries, or Alzheimer’s disease.

When seeing a neurologist, they will start by gathering more information about your general medical history and the concerns that you might have about your thinking skills. They will likely do some basic screening measures such as having you remember a few words, quiz you on the date, and ask you to count backwards. This is called a mental status exam, which helps give them an idea about whether you show signs of overall cognitive impairment.

If they have concerns that there may be a dementia condition present or feel that they need more information, they will send you off for brain imaging. Most commonly, they will order an MRI and an EEG. An MRI, or Magnetic Resonance Imaging, is a type of brain scan that allows your neurologist to look at the overall structure of your brain and see whether there is any evidence of atrophy (breakdown in the tissue of the brain) or issues with the blood vessels in the brain. An EEG, or electroencephalogram, is a non-invasive procedure in which electrodes are placed on the outside of your head to measure your brain’s electrical activity. This is helpful for looking at possible seizure activity or detecting overall problems with the brain’s functioning.

Once this process is started, the neurologist will often become the point person to manage your care. For the issue of possible dementia, you will continue following up with them, and they will be the ones to decide on a final diagnosis, if applicable. 

Neuropsychological assessment tests thinking skills

Brain scans and medical evaluations are great to determine whether there are signs of dysfunction in the brain, but they don’t actually tell you anything about how your brain is working. You can have two people with similar looking brains and they will have very different levels of memory and daily functioning. To determine whether you are showing any signs of decline in thinking abilities, you may need to see a neuropsychologist.

A neuropsychologist is a psychologist, not a medical doctor (Ph.D. vs M.D.), and they focus on evaluating memory, language, reasoning ability, and other thinking skills through a process called neuropsychological assessment. Unlike tests that you may have taken in school, the point of neuropsychological assessment is not to get 100% (nobody does). Instead, your scores on tests are compared to what is considered normal for your age range and education level. So on tests of processing speed (how quickly you think), you would expect someone in their 20s to have higher scores than someone in their 80s, but both scores could be normal for their age range. 

The neuropsychological assessment process is non-invasive and mostly low-tech. You will start with an interview about your current symptoms and some of your personal history. For this interview process, the psychologist will often ask for another family member or close friend be there so that they can give their perspective on any changes that they have seen (it’s hard to see difficulties in yourself). Times definitely vary between providers, but typically the interview takes anywhere from 30 minutes to two hours. After this, you will begin doing the tests.

Typically, neuropsychological assessments involve several different tests. Each test will be around 5-15 minutes in length and a series of different tests are used to look at each thinking skill. Memory will be assessed along with other skills such as speed of processing, language abilities, attention, and reasoning skills. As time goes on, more computers and tablets are integrated into this process, but currently most of the assessments are still low-tech and involve pointing to things in a booklet or answering questions verbally. Testing can take anywhere from 2-5 hours and can take place in one or more appointments.

Following the assessment, the neuropsychologist will interpret the test results within the context of your reported symptoms and other history. They will write up a report with their findings, which will typically be sent to your neurologist and (if they are good) they will also have you come back in for a “feedback session” in which they break down the results for you and answer questions. 

It takes a village

The process of getting a diagnosis of dementia is like triangulation. No one test or assessment is going to be sufficient. Looking at the brain helps to determine any physical changes. Evaluating general medical issues will rule out common issues that can cause impairment. Neuropsychological assessment clarifies whether there is any actual impairment in memory or other thinking skills. These are all essential pieces of the puzzle that can help your doctors determine whether there is a dementia condition present and what your next steps should be.