Do I have dementia and how to test for it
Getting a dementia diagnosis is a long and complicated process, which can be a postcode lottery. In some cases where patients are under 65, it can take four years from recognising symptoms to receiving a diagnosis.
In the UK a new study published in The Lancet found that on current trends up to 1.7 million people could be living with dementia in England and Wales by 2040, which is over 40 per cent more than previously forecast, so early testing is needed more than ever.
Isolde Radford is a policy manager at Alzheimer’s Research UK. She leads the charity’s diagnosis work and explains that “getting diagnosed is quite difficult because there isn’t a single test. It is a journey, and you have to rule out numerous other factors first”.
There are no simple, quick tests you can do that will provide a dementia diagnosis. The only way to get a reliable diagnosis is via your GP. Here are all the options you need to know about.
How is dementia diagnosed?
A typical pathway to diagnosis starts with:
Noticeable problems with memory and thinking. Often a family member will notice these problems first and voice concerns. At this stage a GP appointment should be booked, although in many cases stigma delays the initial appointment.
The GP will rule out other common causes of dementia-like symptoms such as low iron levels, low vitamin B12 levels, and infections.
They will give a basic cognitive test, using questions that provide an indication of memory and thinking.
If there are concerns, the individual will be referred to a memory assessment service, or memory clinic, where they will see a specialist such as an old age psychiatrist, geriatrician, or neurologist. Before this they may be visited at home and assessed by a community psychiatric nurse, who is a specialist in dementia care.
At the clinic, a patient will be taken through a series of tests including basic physical examinations to take blood pressure and heart rate. Coordination may be tested and also short-term memory recall.
Radford continues: “You will be asked about family history and early life to determine whether there are any long-term memory problems.
“After that detailed assessment, the results will be sent to a consultant and you will usually be invited for a brain scan, different types of which can look for different changes in the brain.” You may also be offered a blood test or a lumbar puncture to test for proteins called amyloids which can build up and form plaque in the brain, which is linked to Alzheimer’s disease.
All these tests are then assessed to provide a diagnosis.
The signs to be aware of
“Forgetting phone numbers is not a problem, but forgetting how to use the phone that you have had for a while, or starting to lose your capacity to find your way around surroundings where you used to be familiar are concerns,” says Professor June Andrews, a dementia expert who runs an independent dementia consultancy and website.
Other concerns, she says include: not recognising faces, not being able to work things out, not being able to manage your money. “If you have reached the point where you are worried, you should go to your GP.”
There is some hopeful news. At this early stage of mild cognitive impairment, Prof Andrews points out that only a third of people will go on to be diagnosed with dementia. “In a third of people the symptoms get better spontaneously, and another third stay the same,” she says.
Cognitive and neurological tests
People with symptoms of dementia are given numerous tests to check their mental abilities on the route to final diagnosis.
Test for memory difficulties
A common one used by GPs is the general practitioner assessment of cognition (GPCOG). This includes questions such as “what is the date” and “can you tell me something that happened in the news recently”.
Often the patient will be asked to draw a clock face in a specific order with hands set to a specific time. Although this test cannot diagnose dementia, it may show there are memory difficulties that need further investigation.
Tests for mental ability
Other tests are used to assess different mental abilities, including:
Short and long-term memory.
Concentration and attention span.
Language and communication skills.
Awareness of time and place problem-solving ability, and maths skills, as well as balance, sensory response, and reflexes.
These tests may include:
An abbreviated mental test score (AMTS) which is a 10-point test for rapidly assessing elderly patients for the possibility of dementia.
A Montreal cognitive assessment test (MOCA), which is for detecting cognitive impairment.
An ACE III which assesses attention, memory, verbal fluency, language and visuospatial ability.
Are there online tests I can do at home?
Several of the above-mentioned tests can be found online, but the experts caution against using them as a self-diagnosis tool.
Prof Andrews explains: “If you practise them before you do them in a clinic you will skew the answers. There is minimal value, you don’t do yourself any favours. Some people also pass tests well because they have a high level of formal education. The significant measure is how impaired are you in relation to what you used to be able to do?”
Alzheimer’s Research UK has an online brain health check which identifies things you can do to reduce your risks, such as stopping smoking, exercising, keeping blood pressure low, maintaining a healthy social life and having your hearing checked, as there is a strong correlation between hearing impairment and dementia.
Other commonly used tests
Other tests include MMSE, blood tests, depression and mood assessments, and brain imaging.
MMSE test for early detection
The mini–mental state examination (MMSE) or Folstein test is another tool that can be used. It is a 30-point questionnaire used to measure cognitive impairment. It will not diagnose dementia on its own.
Blood tests
Patients may receive a blood test to check for evidence of amyloids. Alzheimer’s Research and the Alzheimer’s Society are currently involved in a £5 million ‘blood biomarker challenge’ funded by the People’s Postcode Lottery which is piloting implementing blood tests in the NHS over the next five years. These can work as a triage system ensuring the right people are referred for more expensive PET scans.
Depression screen and mood assessment
Depression and depressive symptoms consistently have been shown to be associated with a two-fold or more increase in the risk of dementia. The nature of this association is unclear but one 2011 study published in the Archives of General Psychiatry found that people who became depressed late in life had a 70 per cent increased risk of dementia, and those who’d been depressed since middle age were at 80 per cent greater risk.
Brain imaging
The most common type of scan used in dementia diagnosis is a CT scan, which is effective at ruling out other conditions that can cause similar symptoms such as brain injury or stroke. CT scans can also identify changes to brain structures associated with Alzheimer’s and can identify brain shrinkage, another hallmark of dementia. They can also pinpoint structural changes in blood vessels in the brain which are a sign of vascular dementia.
MRI scans may be offered if CT scan results are inconclusive. These can give a more detailed picture.
The most effective type of imaging scan is a PET scan, which uses radioactive substances, known as radiotracers, to visualise physiological activities including blood flow. PET scans can provide a clear picture of abnormal build-up of amyloids and can also show glucose levels within regions of the brain, which give an indication of brain activity.
The facts
Dementia is a set of symptoms that affect memory, problem-solving, language and behaviour. Alzheimer’s disease is the most common type of dementia, followed by vascular dementia, dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD).
Globally, 55 million people live with Alzheimer’s disease and other causes of dementia, a figure set to rise to 139 million by 2050.
Dementia care costs the state £5.2 billion and the individuals affected by the condition £8.3 billion.
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