I was talking with staff from the Alzheimer’s Support Network in Naples after Minder’s Keepers (a memory loss support group for families dealing with early signs of memory loss) about frequently asked questions. They often get asked how do I find out whether I have Alzheimer’s disease? Who do I see first? What should an evaluation consist of?

First, diagnosis of Alzheimer’s disease can be done by either licensed medical personnel such as a physician or nurse practitioner or by a licensed psychologist, usually a neuropsychologist. Where you go first depends on both your insurance coverage and your comfort level. If you have government run Medicare you can see ether a physician or a neuropsychologist first at your own discretion. If you have Medicare replacement or other insurance, check with your carrier first to see what their requirements are. The best evaluation consists of both medical and neuropsychological assessment so you should ultimately do both.

The medical side of the evaluation usually consists of an interview that addresses your concerns, memory screening (usually the 30-item Mini Mental state
Exam), a physical/neurological exam, blood work, and an imaging study. The objective of the medical evaluation is to describe your physical functioning. The interview will cover concerns, medical history, medications, etc. The neurological exam will describe motor (e.g., reflexes, gait) and sensory (sense of smell, visual fields) functions. Blood work describes relevant biology (blood sugars, immune function, thyroid function, etc.). Imaging (MRI, CT scan) provides a picture of your brain to see if there are pathologies such as stroke, bleeds, and tumors.

The medical assessment is necessary to provide answers to questions like are the changes that concern you due to the effects of a head injury. Alternatively, have you had a stroke? Do you have Parkinson’s disease? Are you diabetic? Is your thyroid over or under active? Do you have a vitamin deficiency? These tests allow inferences about whether there are treatable causes of memory loss and confusion. The information obtained also helps with differential diagnosis of conditions like vascular disease, head injury, Lewy body disease, Parkinson’s disease, frontotemporal disease, and Alzheimer’s disease.

But even the most thorough medical evaluation does not address the most critical treatment issue. What are your strengths and weaknesses and how do you use your strengths to compensate for your weaknesses? What still works? A neuropsychological evaluation should focus on what your brain can do. What still works in your memory? How is your ability to make decisions? Can you still reason effectively? Can you use appliances? Treatment plans are best made based on what still works not on what doesn’t work well any longer. The most important part of a neuropsychological evaluation is the feedback.

A thorough evaluation takes time. Family should be included in all phases of evaluation. Feedback should include provide hope, understanding, and defectiveness rather than just a diagnosis. As Alzheimer’s disease unfolds over the course of decade, evaluation is a process that unfolds over time. The first evaluation provides a baseline to work from.