Alzheimer’s Disease Causes Dementia
While Alzheimer’s is a common cause of dementia (60-80% of dementia cases), it isn't the only cause. Dementia is a collection of symptoms that are severe enough to interfere with daily life (e.g. memory loss, difficulties with thinking, reasoning, and behavior).
An accurate Alzheimer’s diagnosis takes more than a simple screening test to rule out other causes. If someone you love received an Alzheimer’s diagnosis from an in office screening, you should have also received a recommendation/authorization for comprehensive diagnostic testing and a second opinion.
Alzheimer’s Can Be Misdiagnosed
There are over 100 diseases that can cause dementia. Some medical conditions that look like Alzheimer’s can be reversed with treatment. Depression, untreated sleep apnea, delirium, medication side effects, thyroid problems, certain vitamin deficiencies, and excessive alcohol consumption can all cause dementia-like symptoms. Diagnostic testing can rule out conditions that look like Alzheimer’s, but aren’t.
Doctors Can Make Mistakes
A 2018 survey revealed that 33% of U.S. physicians spent 17-24 minutes with their patients. The rest spent less time. Many doctors in the survey saw between 11 and 20 patients a day and felt that their time with patients was limited. Another recent study showed 20% of people diagnosed with Alzheimer’s didn’t have it.
Medicare Reimbursement
Before 2017, there was no specific Medicare reimbursement for dementia testing, so many doctors did not take the time to do it. With limited time to spend with patients and no Medicare reimbursement, many doctors either stopped testing altogether, or only used a screening test for memory loss. Today, primary care doctors who test patients for cognitive impairment during their yearly “Wellness” visit can bill Medicare for their services. Read more about reimbursement from Medicare here.
If your diagnosis was based off a five minute screening test, and your doctor’s treatment plan was “see you in six months,” you have options.
Get The Right Alzheimer's Tests
Screening vs. Diagnostics: What’s The Difference?
Alzheimer's affects more than memory and can be detected using advanced diagnostic tests. Screening tests aren’t the same as diagnostic tests. Screening tests look for possible symptoms of brain disfunction, like memory loss, or behavioral changes. Screening tests are subjective, relying on the experience and intuition of the doctor administering the test. Diagnostic tests are objective, confirming the presence of a specific disease with clear “biomarkers” like a protein in your cerebrospinal fluid or abnormal brain activity.
Medical History
Why it matters:
Doctors look at current and recent medical conditions, current medications, and family history of Alzheimer’s disease or other memory disorders.
Make it count:
Complete a Medication Review at home before your appointment. Email or fax it to your doctor’s office before your appointment, and bring it to your appointment. Download a Medication Review Sheet here.
Medical Milestones And Memory Loss
If your loved one is seeing a doctor for memory problems, remembering any recent medical milestones might be difficult. They might forget things like surgeries, hospital stays, rehabilitation hospital stays, physical therapy, emergency room visits, falls, etc.. Be prepared to fill in the gaps with any health events they’ve experienced over the last three years. Why three years? Most people experience Alzheimer’s symptoms for 2-3 years before seeing a doctor.
Vital Signs
Why it matters:
Blood pressure, heart rate, and temperature are visible markers of good health. Changes in vital signs are also the first indicators of illness and infection throughout our bodies.
Make it count:
Monitor your loved one’s vital signs at home, so you know what’s normal for them before they start any new Alzheimer’s medications.
Vision & Hearing Exams
Why it matters:
Vision and hearing loss can be related to cognitive decline in some people.
Make it count:
If your loved one is struggling to see or hear, tell your doctor.
Smell Test
Why it matters:
Unlike vision and hearing, smell testing is not routinely performed by physicians. Why request it? A smell disorder can be an early sign of Parkinson’s disease, Alzheimer’s disease, or multiple sclerosis. It can also be related to other medical conditions, such as obesity, diabetes, hypertension, and malnutrition.
Make it count:
The University of Pennsylvania Smell Identification Test (UPSIT) has been used successfully to detect Alzheimer's. Request a smell test.
Heart, Lung & Organs Exam
Why it matters:
Heart failure, liver disease, kidney failure, thyroid disorders, and respiratory diseases can cause dementia-like symptoms.
Make it count:
If you have noticed your loved one struggling with specific health issues, notify the doctor’s office before your visit. Complete an Alzheimer’s Signs Review at home before your appointment, and send it to your doctor’s office before your visit. Download an Alzheimer’s Signs Review Sheet here.
Blood & Urine Tests
Why it matters:
These tests screen for other causes of symptoms including blood counts, vitamin levels, liver and kidney function, thyroid gland function, mineral balance, toxic elements, and evidence of an abnormal immune response.
Make it count:
Prepare for the tests. Ask your doctor about fasting and medications before the test. If you haven't reviewed your medications in the last year, consider doing that now. Complete a Medication Review at home before your next appointment. Send it to your doctor’s office before your visit. Download a Medication Review Sheet here.
Neurological Evaluation
Why it matters:
Alzheimer’s negatively impacts reflexes, coordination, eye movement, speech, and sensation. Neurologic abnormalities may indicate a brain disorder besides Alzheimer’s disease. Muscle strength, coordination, reflexes, senses, eye movement, and the pupils’ reaction to light can signal the condition of specific areas of the brain. A neurological evaluation can include tests like EEG, or neuroimaging (e.g., CT or MRI scan).
Make it count:
Complete an Alzheimer’s Signs Review at home before your appointment, and send it to your neurologist's office before your visit. Download an Alzheimer’s Signs Review Sheet here.
Mental Status Testing
Why it matters:
Cognitive screening tests evaluate memory, problem-solving, focus, counting, and language skills. This type of testing can also monitor the progress of Alzheimer’s disease.
Make it count:
Get tests that measure more than memory loss. Why? Alzheimer’s affects more than memory:
- Memory
- Language
- Orientation
- Executive Functions
- Praxis (Actions)
- Visuospatial Abilities
- Attention
In a recent study, thirty-eight Cognitive screening tests were compared. The results show that not all tests results are equal.
Short Screening Tests (lasting less than <5 minutes)
None of the twelve quick screening tests evaluate all seven areas affected by Alzheimer’s. (Memory, Language, Orientation, Executive Functions, Praxis (Actions), Visuospatial Abilities, and Attention)
Longer Screening Tests (lasting between 5 – 20 minutes)
Of twenty-six longer screening tests, only two tests screened for all seven areas:
- The Cognitive State Test (COST)
- The Montreal Cognitive Assessment (MoCA).
Neuropsychological Evaluation
Why it matters:
It is a thorough assessment of skills and abilities linked to brain function. It includes tests to assess memory, language, attention, visuospatial skills, planning and reasoning, problem-solving, the ability to change behavior, as well as personality and emotional stability. This type of testing can also monitor the progress of Alzheimer’s disease.
Make it count:
Transfer your medical records, including the recent assessments from your GP to your Neuropsychologist before your appointment. If significant time has passed between your first assessments and your Neuropsychological Evaluation, take time to revisit the Alzheimer’s Signs Review and Medication Review. Has anything changed? If it has:
Complete an Alzheimer’s Signs Review at home before your appointment, and send it to your neuropsychologist’s office before your visit. Download an Alzheimer’s Signs Review Sheet here.
Complete a Medication Review at home before your appointment, and send it to your neuropsychologist’s office before your visit. Download a Medication Review Sheet here.
Lumber Puncture
Why it matters:
This test is also known as a spinal tap. It checks cerebrospinal fluid (CSF) biomarkers for Alzheimer’s. These are the tau and amyloid proteins that form the plaques and tangles in the brain.
Make it count:
Be sure you understand how to prepare, what to wear, what happens after, and when you’ll see the results.
EEG (Electroencephalogram)
Why it matters:
EEG’s screen for abnormal brain wave activity due to delirium, which has dementia-like symptoms. They also screen for Creutzfeldt-Jakob disease, which causes a type of dementia that progresses faster than Alzheimer’s.
Make it count:
Be sure you understand how to prepare, how long it will take, and when you’ll see the results.
Brain Imaging
Brain imaging can show how Alzheimer’s changes the brain’s structure, can diagnose Alzheimer’s early, and improves the opportunities for managing symptoms.
Computed tomography (CT).
Why it matters:
CT scans reveal physical changes in brain tissue structure seen in the later stages of Alzheimer’s disease.
Magnetic resonance imaging (MRI)
Why it matters:
MRI scans screen out conditions that cause brain atrophy and mimic Alzheimer’s symptoms like strokes, tumors, the buildup of fluid on the brain.
Positron emission tomography (PET)
Why it matters:
PET scans show the abnormal brain activity from Alzheimer’s and can help diagnose Alzheimer’s from other forms of dementia.
Amyloid PET
Why it matters:
Amyloid PET scans show the buildup of amyloid protein in the brain associated with Alzheimer’s
FDG PET
Why it matters:
FDG PET scans show how well brain cells use glucose. Glucose absorption decline is a sign of Alzheimer’s disease.
Get The Right Alzheimer's Doctors
There’s more than one type of doctor to diagnose and treat Alzheimer’s. You have options.
Primary Care Physician (PCP)
Also know as General Physician/General Practitioner/GP, Internist
PCP Specialty
Internal Medicine – Internists typically treat adults and specialize in the prevention, diagnosis, and management of disease and chronic conditions.
PCP Advantages
As your Primary Care Physician, this is the doctor you see most often. They might know you better than someone who is just seeing you for the first time. They might be the first physician you or your loved one talked to about memory loss. Their office is familiar with your Pharmacy and getting medications for you in a timely fashion.
PCP Referrals
In some cases, you will need their referral to see a specialist.
Neurologist
Neurology is the evaluation and treatment of disorders that affect the brain, spinal cord, and nerves.
Neurologist Specialty
Behavioral neurology, a subspecialty of neurology, evaluates, and treats the impact of neurological damage and disease on behavior, memory, and cognition. Neuropsychiatry and Neuropsychology are associated with behavioral neurology.
Neurologist Advantages
Neurological evaluations are specialized, focusing on the brain, spinal cord, and nerves. Precision tests include screening for Alzheimer’s biomarkers, brain atrophy, and abnormal brain activity.
Specialized evaluations can lead to a more specific treatment, personal disease management, and a better quality of life after an Alzheimer’s diagnosis.
Neurologist Training
In the United States and Canada, neurologists are physicians having completed postgraduate training in neurology after graduation from medical school. Neurologists complete, on average, about eight years of medical college education and clinical training, which includes obtaining a four-year undergraduate degree, a medical degree (DO or MD), which comprises an additional four years of study, then completing one year of basic clinical training and four years of residency.[6]The four-year residency consists of one year of internal medicine internship training followed by three years of training in neurology.
- Four years of pre-medical education in a college or university
- Four years of medical school – M.D. or D.O.
- One year internship in either internal medicine or medicine/surgery
- At least three years of specialty training in an accredited neurology residency program
Many neurologists also have additional training or interest in one area of neurology, such as behavioral neurology.
Neurology Professional Associations
American Academy of Neurology
https://www.aan.com
AAN Patient Site
https://www.brainandlife.org/
American Neurological Association (ANA)
https://myana.org/
Find A Neurologist
https://www.brainandlife.org/findaneurologist
https://www.abpn.com/check-physician-status/search-board-certified-physician/
Neurology Video
Why I Think Neuroscience is….™ Essential
Neuropsychologist
A neuropsychologist is a specialized psychologist with expertise in the applied science of brain-behavior relationships, focusing on how brain function affects cognitive, emotional, and behavioral processes. Illnesses, injuries, brain diseases (like Alzheimer's disease) and nervous system diseases can affect the way a person feels, thinks, and behaves. They work closely with doctors, including neurologists.
A neuropsychological evaluation is an assessment of how the brain functions. Neuropsychological evaluations indirectly yield information about brain structural and functional integrity. In general, evaluations involve an interview and various pencil and paper tests.
Neuropsychological evaluations are an in-depth assessment of skills and abilities linked to brain function. The evaluation measures such areas as attention, problem-solving, memory, language, I.Q., visual-spatial skills, academic skills, and social-emotional functioning.
Neuropsychology Advantages
Neuropsychological evaluations are an essential piece of the diagnostic assessment for people with Alzheimer's. They can include a complete physical, neurological exam, lab tests, and a brain scan.
- Testing can facilitate a more accurate and earlier diagnosis, allowing you and your loved one to better plan for the future.
- Testing can provide a reliable baseline, or starting point, for tracking changes in cognitive function over time.
- Testing provides details about your loved one's current strengths and weaknesses and can help you cope with challenges.
- Testing can help guide medical decision-making, such as whether you need other specialized tests or medication.
- Testing also can help you and your family make decisions regarding assistance with financial matters, living arrangements, or other activities of daily living.
Neuropsychologist Training
In order to become a neuropsychologist, you need to obtain a doctorate degree, a Ph.D. in neuropsychology. A Ph.D. can take approximately five to eight years of coursework, including a research project (your dissertation) and an exam. To obtain a Ph.D., you first need to earn a bachelor's degree.
Neuropsychology Professional Associations
American Academy of Clinical Neuropsychology (AACN)
http://www.theaacn.org/
National Academy of Neuropsychology (NAN)
https://www.nanonline.org/
International Neuropsychological Society (INS)
http://www.the-ins.org/
American Board of Clinical Neuropsychology: ABCN
https://theabcn.org/
Society for Clinical Neuropsychology (Division 40)
https://www.apa.org/about/division/div40
Find A Neuropsychologist
AACN Directory Search
https://theaacn.org/directory/
American Board of Professional Psychology
https://www.abpp.org/Directory
Geriatrician
Also known as Geriatrist, Geriatric Physician
Geriatricians are primary care physicians who specialize in wellness, preventive health, and managing chronic medical conditions in older adults. In other words, they diagnose and treat conditions that may commonly occur with age. Geriatricians focus on maintaining well-being and independence based on high-quality, person-centered care.
Geriatricians often work in centers and use a team-based approach, collaborating with other health professionals specializing in caring for older adults. These can include audiologists, registered dietitians, physical therapists, occupational therapists, mental health professionals, and social workers. This means that you may meet with several healthcare professionals in the same visit. For example, a hearing specialist, psychologist, and physical therapist.
Geriatrician Advantages
Geriatricians use a whole-person approach to healthy aging. A Geriatric Assessment is a multidimensional, multidisciplinary evaluation for physical, psychological, social, and environmental conditions.
According to the American Geriatrics Society (AGS), Geriatrician’s target areas for healthy aging are the 5M’s©:
- Knowing what Matters to us as older adults when it comes to making healthcare decisions
- Reviewing, reducing, and removing Medications that may cause harm or are unnecessary
- Improving care for the Mind by addressing critical problems like dementia, delirium, and depression
- Promoting Mobility, or the medical term for being able to move (on our own or with help)
- Multi-complexity—or the need to manage multiple health conditions at once
Geriatrician Training
- Four-year undergraduate degree in premedical education in a college or university
- Four-year medical degree from a qualified medical school (M.D. or D.O.)
- Complete 3 to 5 years of full-time experience in a residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME)
- Provide letters of attestation from a program director and faculty
- Obtain an unrestricted medical license to practice medicine in the United States or Canada
- Board certification from the American Board of Internal Medicine (ABIM) or the American Board of Family Medicine (ABFM).
Geriatric Associations
American Geriatrics Society (AGS)
https://www.healthinaging.org/about-us/about-american-geriatrics-society
How To Find a Geriatrician
American Geriatrics Society (AGS)
https://www.healthinaging.org/find-geriatrics-healthcare-professional
If You Have Alzheimer’s, Why Bother?
Alzheimer’s can be misdiagnosed—even by experts. Proper screening for other conditions that mimic Alzheimer’s eliminates conditions that could be treatable and reversible.
A multi-disciplinary, team approach with a precise diagnosis, means a better quality of life for you and your loved one living with Alzheimer’s.
2 in 10 Alzheimer's Cases May Be Misdiagnosed
2019 Alzheimer's disease facts and figures
AACN Directory Search
Accuracy of the Clinical Diagnosis of Alzheimer Disease at National Institute on Aging Alzheimer's Disease Centers, 2005–2010
Alzheimer’s Diagnosis and Tests
Alzheimer's Disease May Be Easily Misdiagnosed
American Academy of Clinical Neuropsychology (AACN)
American Academy of Neurology
American Academy of Neurology – Patient Site
American Board of Clinical Neuropsychology: ABCN
American Board of Professional Psychology
American Board of Psychiatry and Neurology, Inc.- Board Certified Physician Search
American Geriatrics Society (AGS)
American Neurological Association
Amount of time U.S. primary care physicians spent with each patient as of 2018
Assessing olfactory abilities with the University of Pennsylvania smell identification test: A Rasch scaling approach (2002)
Behavioral Neurology
Brief cognitive screening instruments for early detection of Alzheimer’s disease: a systematic review (2019)
COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients. (2013)
Dementia-like symptoms: What else could it be?
Diagnosis of Alzheimer’s disease with Electroencephalography in a differential framework
Find A Geriatrics Professional
How to Become a Neuropsychologist
International Neuropsychological Society (INS)
Medicare Yearly “Wellness” Visits
Misdiagnosis of Alzheimer’s Disease Is Linked to Less Severe Dementia Profile
National Academy of Neuropsychology (NAN)
Neurology
Neuropsychological Evaluation FAQ
Neuropsychological Testing for People with Dementia
New Medicare Rule Encourages Doctors to Test for Alzheimer's Disease and Offer Care Planning
Paper Cognitive Tests
PET scans show many Alzheimer’s patients may not actually have the disease
Recognizing Alzheimer’s Disease: Early Warning Signs & Diagnosis
Research highlights misdiagnosis for people with Alzheimer’s disease
Smell identification function as a severity and progression marker in Alzheimer's disease.
Society for Clinical Neuropsychology (Division 40)
Some Alzheimer’s patients might have been misdiagnosed, study suggests
The Geriatric Assessment
The pain of being misdiagnosed with Alzheimer's is more common than we realize, doctors say
Training For Geriatricians
Types Of Dementia
United Council for Neurologic Subspecialties
What is a Neurologist?
What Is a Neuropsychological Evaluation?
What is a neuropsychologist?
When It’s Time to See a Geriatrician
Why I Think Neurology is….™ Essential
