Getting a diagnosis
If you suspect that you or someone you care about is showing symptoms of dementia or memory loss, you should contact your family doctor as soon as possible.
A diagnosis will usually be made depending on how you are affected, your family history and psychological changes. It is often useful to bring someone with you when you see your family doctor who can help answer questions.
The earlier a diagnosis is made, the more effective treatment can be. For example, prompt use of medication may help delay symptoms, as well as improving those which already exist.
A diagnosis is important to rule out other possible causes of confusion, such as poor sight or hearing; emotional changes and upsets, such as bereavement; or the side-effects of certain drugs or combinations of drugs.
Getting a diagnosis will also ensure timely access to advice and information and allow you and your Carers to plan and make arrangements for the future.
Whether a diagnosis of dementia comes as a shock or confirms your suspicions, you could experience a range of emotions – you may feel numb, frightened, angry, worried, sad, guilty or frustrated.
However, you may also feel relieved to find there is a medical reason for your memory problems.
Although there is currently no cure for dementia, with treatment and support many people who have the condition lead active, fulfilling lives.
What tests are involved?
A range of tests and diagnostic procedures is needed to diagnose dementia. The following are the most commonly used.
Assessing mental abilities to diagnose dementia
Questionnaires are often used to help test the mental abilities of the person with symptoms of dementia, and how severe they are. One widely used test is the mini mental state examination (MMSE). The MMSE assesses a number of different mental abilities, including:
- short- and long-term memory
- attention span
- concentration
- language and communication skills
- ability to plan
- ability to understand instructions
The MMSE is a series of exercises, each carrying a score with a maximum of 30 points. Example exercises include:
- memorising a short list of objects and then repeating the list
- writing a short sentence that is grammatically correct, such as "the dog sat on the floor"
- correctly answering time-orientation questions, such as identifying the day of the week, the date or the year
The MMSE is not a test to diagnose dementia. However, it is useful for assessing the level of mental impairment that a person with dementia may have.
Test scores may be influenced by a person's level of education. For example, someone who cannot read or write very well may have a lower score, but they may not have dementia. Similarly, someone with a higher level of education may achieve a higher score but still have dementia.
Blood tests for dementia
A person with suspected dementia may have blood tests to check their overall level of health and to rule out other conditions that may be responsible for their symptoms, such as thyroid hormones and vitamin B12 levels.
Dementia brain scans
Brain scans are usually used for diagnosing dementia. They are needed to check for evidence of other possible problems that could explain a person's symptoms, such as a major stroke or a brain tumour.
Several types of brain scan can be used to help diagnose dementia:
Computerised tomography (CT) scan
A computerised tomography (CT) scan can be used to check for signs of stroke or a brain tumour. However, unlike an MRI scan, a CT scan cannot provide detailed information about the structure of the brain.
Magnetic resonance imaging (MRI) scan
The National Institute for Health and Care Excellence (NICE) recommends using a magnetic resonance imaging (MRI) scan to help confirm a diagnosis of dementia.
An MRI scan can provide detailed information about the blood vessel damage that occurs in vascular dementia, plus any shrinking of the brain (atrophy). In Alzheimer's disease, the whole brain is susceptible to shrinking, whereas in frontotemporal dementia the frontal and temporal lobes are mainly affected by shrinking.
Other scans and procedures
Other types of scan, such as a single photon-emission computed tomography (SPECT) scan or a positron emission tomography (PET) scan, may be recommended if the result of your CT or MRI scan is uncertain. These scans look at how the brain functions and can pick up abnormalities with the blood flow in the brain.
In some cases, an electroencephalogram (EEG) may be taken to record the brain's electrical signals (brain activity).
A lumbar puncture may also be used to check the protein levels in the brain. This procedure involves taking a sample of spinal fluid from the lower back for testing
Treatment for dementia
As drugs for treating different conditions become available, it is becoming increasingly important to identify which type of dementia the person has.
For example, drugs are already available to treat some people with Alzheimer’s disease and some people with dementia with Lewy Bodies.
Although there is no cure, medication can stabilise the condition for a while.
Medication should be reviewed regularly and continued so long as the drug benefits outweigh any side-effects.
At present, there are no treatments that can reverse the progress of dementia once it has developed.
However, there are drugs that may alleviate some of the symptoms of Alzheimer’s disease, for a limited period of time.
These drugs (Aricept, Exilon and Reminyl) are known as cholinesterase inhibitors and they prevent enzymes related to Alzheimer’s Disease breaking down in the brain.
Medication can provide some people with improvements in confidence, daily activities, memory and thinking. In some cases, it can also temporarily slow down the progression of symptoms.
However, they don’t work for everyone and the medication can cause a number of side effects (the most common side effects are loss of appetite, nausea, vomiting and diarrhoea).
Treatment for vascular dementia
People with vascular dementia will be treated for their vascular disease to try to prevent it from worsening. This may involve taking drugs to lower blood pressure and making lifestyle changes.
People will especially benefit from a healthier lifestyle by stopping smoking, taking regular exercise, eating healthily, and drinking alcohol only in moderation.
Complementary and alternative medicine
For those who wish to consider the help that complementary and alternative therapies may offer, an Alzheimer’s Society factsheet outlines several therapies and describes how to access them.
Therapies for which there is some evidence of effectiveness include aromatherapy, music therapy, acupuncture, light therapy, massage, and herbal therapy.
Psychological treatments for dementia
Psychological treatments do not slow down the progression of dementia, but they can help with coping with the symptoms. Some psychological treatments are outlined below.
Cognitive stimulation and reality orientation therapy
Cognitive stimulation involves taking part in activities and exercises designed to improve your memory, problem-solving skills and language ability.
Reality orientation therapy is a type of therapy that reduces feelings of mental disorientation, memory loss and confusion, while improving feelings of self-esteem.
The therapy may involve group work in a classroom, in which a board prominently displays information such as:
- the current day and date
- the location of the classroom
- the names of the people in the group
The group members repeat a series of tasks designed to give mental stimulation. The tasks also reinforce information regarding the time, the place and the people involved in the group. You will be involved in discussions about a variety of topics, as well as taking part in word and memory games.
Evidence suggests that cognitive stimulation can help improve thinking and memory skills in people with dementia and it is currently the only psychological treatment specifically recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of mild to moderate dementia.
Reality orientation may also be beneficial in some cases, but the benefits can be small and are often only apparent with continued effort. The technique is also often considered unsuitable for use in care home settings.
Validation therapy
Validation therapy is a type of therapy that focuses on dementia from an emotional, rather than factual, perspective. It is based on the principle that even the most confused behaviour has some meaning for the person.
For example, if someone with dementia becomes agitated at a certain point every day because they believe their mother is going to come and pick them up, telling them that their mother is no longer alive could cause them to become more agitated and distressed.
With validation therapy, the response to this situation might involve not correcting the person and accepting their concerns, but talking to them about the issue and gradually steering the conversation in another direction. In theory, this should reduce their distress, while acknowledging that their thoughts and feelings have meaning for them.
However, while validation therapy may sometimes be used as part of the treatment of someone with dementia, there is currently not enough evidence about the effectiveness of this approach to be certain whether or not it is beneficial.
Behavioural therapy
Behavioural therapy tries to find reasons for difficult behaviour. Different strategies are adopted to try to change that behaviour.
For example, a person with dementia may have a history of wandering out of their home or care centre because they feel restless. Therefore, encouraging them to take part in regular physical exercise may help to decrease their restlessness.
Behavioural therapy can be used to treat many of the behavioural problems that are associated with dementia, such as depression, aggression and delusional thinking. It is usually given by a Carer, such as a trained friend or relative, or by an employed Carer. It is supervised by a healthcare professional.