What tests did they use to diagnose your loved on with Alzheimer's Disease?

Snowe

My mother is currently in the processed of being diagnosed. The doctor is doing a few blood tests to rule out reversable causes for the cognitive difficulties but otherwise says no tests are needed besides a brief cognitive measure (MOCA) to diagnose Alzheimer's. What was your experience like? Did they do more testing or imaging?

Stuck in the middle

Imaging (like CT) is useful to rule out strokes and brain tumors.  I have seen it save lives.

jfkoc

Moca is not able to diagnose AD. It only measures cognitive impairment.

https://www.mocatest.org

You already know there is cognitive impairment so what you are trying to find out is what is causing the dementai now that reversable things have been ruled out.

This can be a long and changing process but it is important but the drugs are not one size fits all.

In the meantime there is a lot to learn about non-medical treatment or caregicer 101. Also a good time to get legal and financial matters in order.

ninalu

Hi Snowe,
My LO had a lot of labwork to rule out things that resemble dementia (B-vitamin deficiencies, hypothyroid, some autoimmune markers, as I recall.) Then she had a CT - they were looking for hydrocephalus and thought that maybe she did. The neurologist then recommended a PET scan. Clinical signs and symptoms were already strong, but the scan was considered final confirmation for Alzheimer's. She was early mid-stage when all this was done. We haven't done any more brain scans since. 

Best wishes to you and your mom.

Snowe

Thank you!~ They only gave my mom the MOCA and took information from me about what our family sees. He said that he only needs additional imaging or testing in borderline cases. While I think there is probably dementia of some sort, I keep wondering if more should be done to be sure which one it is and which treatment is best.

Stuck in the middle

The diagnostic question isn't whether there is dementia, the question is what causes the dementia you observe.  Dementia symptoms such as memory loss can be caused by infections, vitamin deficiencies, depression, brain trauma, drugs, Alzheimer's, and more.  Thus, the tests to rule out treatable illness.

MonicaG

The first test was a mini mental exam from the internist, who then sent my mom for a neuropsych exam.  She did really bad on the mini mental exam. My mom was asked to draw the face of a clock and then make it show a certain time. It was really bad. She drew something totally bizarre. Then we went for a driving evaluation, which they told her that day she can’t drive anymore. But the main diagnosis of Alzheimer’s came from the neuropsych.

Rescue mom

My DH had several medical-type tests and brain scans to rule out treatable illnesses. He also went through a lot of verbal? exams, talking and answering questions, with neurologists, psychs, etc. Like the MMSE but much longer. Several hours, spread out over several days.

 If I recall right, it was the verbal and Q&A that really showed the dementia (99 percent Alzheimer’s). Plus other treatable reasons, like thyroid, vitamin deficiency, tumors etc., were ruled out. But one doc said he was virtually positive after just  one talk session that DH has Alzheimer’s. 

The brain scans were really breathtaking because it was so obvious how much was gone, compared to normal of same age. But they were most useful in showing family who had been insisting there wasn’t anything really wrong with him and he could do/remember things “if he just wanted to” or tried to….

PlentyQuiet

DH had the blood tests, MRI and neuropsych testing done. That gave the diagnosis of MCI. When I pushed a bit that something was wrong, neuro ordered a lumbar puncture (spinal tap) to check for biomarkers. This was positive and so gave the diagnosis of Early Onset Alzheimer's Disease. This was helpful as we needed definitive diagnosis to get social security disability.

MN Chickadee

That is not proper protocol in my humble opinion. I would ask for a referral to neurology. I don't see how the doctor could have ruled out other dementias with just the MOCA. My mother had the lab work MOCA with her PCP and then went on to have a full neuropsych work up, which usually starts with a lengthy appointment with a neuro-psychologist. Then she saw a neurologist briefly for a consult and diagnosis. She had an MRI. All this information put together pointed to Alzheimer's. It was more of putting all the pieces together for the doctor to make an educated calculation. None of the assessment showed the other things that would point to a different dementia (such changes in behavior coming before memory loss, or imaging showing abnormal fluid build up, shrinkage in certain parts of the brain etc.) While Alzheimers is probably the most common, if possible it is really good to find out for sure. Medications used for Alz can be terrible for other forms of dementia and people in that camp often spend many miserable weeks or months dealing with difficulties before figuring this out, if ever. Sometimes it is not possible for a full workup, due to circumstances, finances, the PWD being unwilling to go to appointments, but if possible I would advise doing a neurology consult. This Teepa Snow video is extremely informative on what to expect and ask for as you seek a diagnosis. She kind of describes a perfect process, which not everyone gets for a variety of reasons, but it's something to strive for. 

https://www.youtube.com/watch?v=61dQDIuueyQ

GothicGremlin

My experience mirrors what others have said.  The first thing that we did was to have a neurologist test my sister. Then she had all of the blood work done to eliminate other causes (B vitamin deficiency, etc.). Then she had an MRI, and a PET Scan. It was the MRI and the PET Scan together that clinched it. She was given a diagnosis of early onset Alzheimer's.

ButterflyWings

Our process mirrored the others with full work up, neuropsych eval, and MRI. No red flags with the MRI, and DH was mistakenly given the all clear. A year and many serious mishaps later, new Neuro team re-examined *(him and noted gaps in the prior report and with a new) lower MOCA *(score) plus concerning updates from my LO and me, *(DH) agreed to explore further and lumbar puncture showed beta and tau in clear levels indicative of AD.

*added to clarify OP

harshedbuzz

Dad's workup was in 2 stages and a bit unusual in that the process was begun in the ER because of a psychotic episode. My parents initially fought me on having dad evaluated for the better part of a decade until my dad was too impaired to interfere and my mom was finally backed into a corner. 

She had taken him to their local small town/resort area hospital because my uncle thought he was having a stroke during a phone conversation. They botched the diagnosis, did no bloodwork, which my BIL who is an ER doc, claimed should have been standard-of-care under the circumstances said he'd not had a stroke and discharged him with a referral to a neurologist. A week later, she came home to dad having a complete break from reality. 

We drove him north to the university teaching hospital affiliated with the Memory Center I'd chosen as part of my "Plan B". The resident made dad's initial diagnosis of an alcohol-related dementia (Wernicke-Korsakoff's) in the ER and he was admitted for treatment and observation. While on the neurology floor, the attending changed the working diagnosis to dementia- likely Alzheimer's based on a CT Scan, further history (my mom described his condition as a "sudden onset" whereas I described subtle changes in mood and memory going back 10 years) and some neuropsych testing. Since the results of the Thiamine level blood test weren't back, they continued the treatment started in the ER. Dad was turfed to a SNF for some PT after the hospital and given a follow-up appointment with the Memory Center where a 3rd doctor looked at his tests and history. During this time, with the IV Thiamine on board, he did recover a lot of function and cognition but not to the degree that would have allowed him to be independent. The new doctor ordered a PET scan and did more paper testing. 

A PET scan is not ordinarily ordered, but in dad's case it was meant to distinguish between Wernicke-Korsakoff's and Alzheimer's. His CT scan did show some shrinkage beyond normal aging as well as some white areas that could be signs of injury/TIAs. The PET scan looked for the pattern of glucose uptake which is characteristic of WKS which it found. The new neurologist gave dad a diagnosis of ESLO Alzheimer's and WKS. There was some discussion of VD and even FTD based on behavior (but I think the behavior was more a function of underlying mental illness made harder to mask by a loss of social filter- the geripsych felt so as well).

FWIW, MOCA and MMSE tests were used at his follow-up and geripsych appointments to track progression. IMO, this is kind of a blunt instrument. Dad didn't struggle emotionally with the testing as some do and always did better than I would have expected given his behavior at home. Dad could still score just below expected for his age/education until about 6-9 months before he died from complications of aspiration pneumonia and was not reliably continent. 

The last time he did the test, he bragged how well he did all in the elevator all the way to the lobby. "Off the charts", "Never seen someone so brilliant", etc.  He did do pretty well with certain pieces like the animals and serial subtraction. And then he wandered off to some random woman's car and got in while I was turning in our valet ticket. The look on her face was priceless. 

HB

ColetteMomko

For my mom her PCP did a urine analysis to rule out a UTI (which can create dementia symptoms in elderly) and then a neurologist ran some simple verbal cognitive tests before recommending an MRI. The MRI lead to a a Alzheimer's diagnosis.

QuincyLF

Definitely have a neurosurgeon review the CAT scan to rule out normal pressure hydrocephalus (NPH).  Especially if there is a change in walk/gait, incontinence in addition to the memory loss.  The 2nd article is particularly interesting.  Remember to ask for another CAT scan if you notice gait & sudden onset incontinence in the future too.  My dad has ALZ for 5 years, and we just discovered NPH due a recent change in his condition.  His early CAT scans didn't indicate NPH.  It was more recent.

https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/normal-pressure-hydrocephalus

https://www.webmd.com/brain/normal-pressure-hydrocephalus

jfkoc

If the proper protocal is not followed you do not have the best diagnosis!!!

DenaH

My Mom is in the process of getting a diagnosis. Her PCM did a quick assessment that she didn't do well at (didn't know the Month/Year, current President, the name of the doctor's office we were at) and gave her a referral to a neuro practice that specializes in memory issues.

Her first appt with them included a more thorough assessment, and we walked out with appts for an MRI, EEG, and neuro-psych eval. MRI and EEG were last week; NPE is on the 22nd of this month.

Based on her symptoms (short-term memory is pretty shot, paranoia, and is very, very confused) we expect a diagnosis of Alzheimer's or other dementia.  Which Mom is aware enough that the diagnosis is going to make her very angry.

jfkoc

Dena...were all"treatable" causes ruled out?