An important part of diagnosing Alzheimer's disease includes being able to explain your symptoms, as well as perspective from a close family member or friend about symptoms and their impact on daily life. Additionally, a diagnosis of Alzheimer's disease is based on tests your doctor administers to assess memory and thinking skills.
Laboratory and imaging tests can rule out other potential causes or help the doctor better identify the disease causing dementia symptoms.
But Alzheimer's disease is only diagnosed with complete certainty after death, when microscopic examination of the brain reveals the characteristic plaques and tangles.
A diagnostic work-up would likely include the following tests:
Physical and neurological exam
Your doctor will perform a physical exam and likely assess overall neurological health by testing the following:
- Muscle tone and strength
- Ability to get up from a chair and walk across the room
- Sense of sight and hearing
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as a thyroid disorder or vitamin deficiencies.
Mental status and neuropsychological testing
Your doctor may give you a brief mental status test to assess memory and other thinking skills. Longer forms of neuropsychological testing may provide additional details about mental function compared with people of a similar age and education level. These tests can help establish a diagnosis and serve as a starting point to track the progression of symptoms in the future.
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer's.
Imaging of brain structures include the following:
- Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of the brain. While they may show brain shrinkage of brain regions associated with Alzheimer's disease, MRI scans also rule out other conditions. An MRI is generally preferred to a CT scan for the evaluation of dementia.
- Computerized tomography (CT). A CT scan, a specialized X-ray technology, produces cross-sectional images (slices) of your brain. It's usually used to rule out tumors, strokes and head injuries.
Imaging of disease processes can be performed with positron emission tomography (PET). During a PET scan, a low-level radioactive tracer is injected into the blood to reveal a particular feature in the brain. PET imaging may include the following:
- Fluorodeoxyglucose (FDG) PET scans show areas of the brain in which nutrients are poorly metabolized. Identifying patterns of degeneration — areas of low metabolism — can help distinguish between Alzheimer's disease and other types of dementia.
- Amyloid PET imaging can measure the burden of amyloid deposits in the brain. This imaging is primarily used in research but may be used if a person has unusual or very early onset of dementia symptoms.
- Tau PET imaging, which measures the burden of neurofibrillary tangles in the brain, is generally used in the research setting.
In special circumstances, such as rapidly progressive dementia, dementia with atypical features or early-onset dementia, other tests may be used to measure abnormal beta-amyloid and tau in the cerebrospinal fluid.
Future diagnostic tests
Researchers are working to develop tests that can measure biological signs of disease processes in the brain.
These tests, including blood tests, may improve the accuracy of diagnoses and enable earlier diagnosis before the onset of symptoms. A blood test for Plasma Aβ is currently available and recently received certification in the U.S. by the Centers for Medicare & Medicaid Services to allow distribution on the market.
Genetic testing generally isn't recommended for a routine Alzheimer's disease evaluation. The exception is people who have a family history of early-onset Alzheimer's disease. Meeting with a genetic counselor to discuss the risks and benefits of genetic testing is recommended before undergoing any tests.
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
Cholinesterase inhibitors. These drugs work by boosting levels of cell-to-cell communication by preserving a chemical messenger that is depleted in the brain by Alzheimer's disease. These are usually the first medications tried, and most people see modest improvements in symptoms.
Cholinesterase inhibitors may also improve neuropsychiatric symptoms, such as agitation or depression. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon).
The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with certain heart disorders, serious side effects may include cardiac arrhythmia.
- Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease. It's sometimes used in combination with a cholinesterase inhibitor. Relatively rare side effects include dizziness and confusion.
Sometimes other medications such as antidepressants may be prescribed to help control the behavioral symptoms associated with Alzheimer's disease.
Creating a safe and supportive environment
Adapting the living situation to the needs of a person with Alzheimer's disease is an important part of any treatment plan. For someone with Alzheimer's, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.
You can take these steps to support a person's sense of well-being and continued ability to function:
- Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don't become lost.
- Keep medications in a secure location. Use a daily checklist to keep track of dosages.
- Arrange for finances to be on automatic payment and automatic deposit.
- Have the person with Alzheimer's carry a mobile phone with location capability so that a caregiver can track its location. Program important phone numbers into the phone.
- Install alarm sensors on doors and windows.
- Make sure regular appointments are on the same day at the same time as much as possible.
- Use a calendar or whiteboard in the home to track daily schedules. Build the habit of checking off completed items.
- Remove excess furniture, clutter and throw rugs.
- Install sturdy handrails on stairways and in bathrooms.
- Ensure that shoes and slippers are comfortable and provide good traction.
- Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing or frightening.
- Make sure that the person with Alzheimer's carries identification or wears a medical alert bracelet.
- Keep photographs and other meaningful objects around the house.
Various herbal remedies, vitamins and other supplements are widely promoted as preparations that may support cognitive health or prevent or delay Alzheimer's. Clinical trials have produced mixed results with little evidence to support them as effective treatments.
Some of the treatments that have been studied recently include:
Vitamin E. Although vitamin E doesn't prevent Alzheimer's, taking 2,000 international units daily may help delay the progression in people who already have mild to moderate disease. However, study results have been mixed, with only some showing modest benefits. Further research into the safety of 2,000 international units daily of vitamin E in a dementia population will be needed before it can be routinely recommended.
Supplements promoted for cognitive health can interact with medications you're taking for Alzheimer's disease or other health conditions. Work closely with your health care team to create a safe treatment plan with any prescriptions, over-the-counter medications or dietary supplements.
- Omega-3 fatty acids. Omega-3 fatty acids in fish or from supplements may lower the risk of developing dementia, but clinical studies have shown no benefit for treating Alzheimer's disease symptoms.
- Curcumin. This herb comes from turmeric and has anti-inflammatory and antioxidant properties that might affect chemical processes in the brain. So far, clinical trials have found no benefit for treating Alzheimer's disease.
- Ginkgo. Ginkgo is a plant extract containing several medicinal properties. A large study funded by the National Institutes of Health found no effect in preventing or delaying Alzheimer's disease.
- Melatonin. This supplement of a hormone that regulates sleep is being studied to determine if it offers benefits managing sleep in people with dementia. But some research has indicated that melatonin may worsen mood in some people with dementia. More research is needed.
Lifestyle and home remedies
Healthy lifestyle choices promote good overall health and may play a role in maintaining cognitive health.
Regular exercise is an important part of a treatment plan. Activities such as a daily walk can help improve mood and maintain the health of joints, muscles and the heart. Exercise can also promote restful sleep and prevent constipation — and it's beneficial for care partners, too.
People with Alzheimer's who develop trouble walking may still be able to use a stationary bike, stretch with elastic bands or participate in chair exercises. You may find exercise programs geared to older adults on TV or on DVDs.
People with Alzheimer's may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.
Offer the following:
- Healthy options. Buy favorite healthy food options that are easy to eat.
- Water and other healthy beverages. Encourage drinking several glasses of liquids every day. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger a frequent need to urinate.
- High-calorie, healthy shakes and smoothies. Supplement milkshakes with protein powders or make smoothies featuring favorite ingredients, especially when eating becomes more difficult.
Social engagement and activities
Social interactions and activities can support the abilities and skills that are preserved. Doing things that are meaningful and enjoyable are important for the overall well-being of a person with Alzheimer's disease. These might include:
- Listening to music or dancing
- Reading or listening to books
- Gardening or crafts
- Social events at senior or memory care centers
- Planned activities with children
Coping and support
People with Alzheimer's disease experience a mixture of emotions — confusion, frustration, anger, fear, uncertainty, grief and depression.
If you're caring for someone with Alzheimer's, you can help them cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing support, and doing your best to help the person retain dignity and self-respect.
A calm and stable home environment can help reduce behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. As a person with Alzheimer's becomes upset, the ability to think clearly declines even more.
Caring for the caregiver
Caring for a person with Alzheimer's disease is physically and emotionally demanding. Feelings of anger and guilt, stress and discouragement, worry and grief, and social isolation are common.
Caregiving can even take a toll on the caregiver's physical health. Paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person with Alzheimer's.
If you're a caregiver for someone with Alzheimer's, you can help yourself by:
- Learning as much about the disease as you can
- Asking questions of doctors, social workers and others involved in the care of your loved one
- Calling on friends or other family members for help when you need it
- Taking a break every day
- Spending time with your friends
- Taking care of your health by seeing your own doctors on schedule, eating healthy meals and getting exercise
- Joining a support group
- Making use of a local adult day center, if possible
Many people with Alzheimer's and their families benefit from counseling or local support services. Contact your local Alzheimer's Association affiliate to connect with support groups, doctors, occupational therapists, resources and referrals, home care agencies, residential care facilities, a telephone help line, and educational seminars.
Preparing for your appointment
Medical care for the loss of memory or other thinking skills usually requires a team or partner strategy. If you're worried about memory loss or related symptoms, ask a close relative or friend to go with you to a doctor's appointment. In addition to providing support, your partner can provide help in answering questions.
If you're going with someone to a doctor's appointment, your role may be to provide some history or your thoughts on changes you have seen. This teamwork is an important part of medical care for initial appointments and throughout a treatment plan.
Your primary care doctor may refer you to a neurologist, psychiatrist, neuropsychologist or other specialist for further evaluation.
What you can do
You can prepare for your appointment by writing down as much information as possible to share. Information may include:
- Medical history, including any past or current diagnoses and family medical history
- Medical team, including the name and contact information of any current physician, mental health professional or therapist
- Medications, including prescriptions, over-the-counter drugs, vitamins, herbal medications or other dietary supplements
- Symptoms, including specific examples of changes in memory or thinking skills
What to expect from your doctor
Your doctor will likely ask a number of the following questions to understand changes in memory or other thinking skills. If you are accompanying someone to an appointment, be prepared to provide your perspective as needed. Your doctor may ask:
- What kinds of memory difficulties and mental lapses are you having? When did you first notice them?
- Are they steadily getting worse, or are they sometimes better and sometimes worse?
- Have you stopped doing certain activities, such as managing finances or shopping, because these activities were too mentally challenging?
- How is your mood? Do you feel depressed, sadder or more anxious than usual?
- Have you gotten lost lately on a driving route or in a situation that's usually familiar to you?
- Has anyone expressed unusual concern about your driving?
- Have you noticed any changes in the way you tend to react to people or events?
- Do you have more energy than usual, less than usual or about the same?
- What medications are you taking? Are you taking any vitamins or supplements?
- Do you drink alcohol? How much?
- Have you noticed any trembling or trouble walking?
- Are you having any trouble remembering your medical appointments or when to take your medication?
- Have you had your hearing and vision tested recently?
- Did anyone else in your family ever have memory trouble? Was anyone ever diagnosed with Alzheimer's disease or dementia?
- Do you act out your dreams while sleeping (punch, flail, shout, scream)? Do you snore?