What is a Diagnostic Evaluation?
For individuals experiencing memory problems, a comprehensive diagnostic evaluation is the first step toward determining the nature and significance of the problems, and getting the right care. Memory problems can result from many different medical conditions, including Alzheimer’s disease and Mild Cognitive Impairment, or they can be a result of normal aging (age-related cognitive decline). A diagnostic evaluation is the only way health care providers can assess a person's condition and provide an accurate diagnosis. The diagnosis then determines appropriate treatment and care options, as well as an accurate forecast of the course of the problem (what doctors call "a prognosis").
A diagnostic evaluation can also provide reassurance for aging individuals who are not currently experiencing symptoms, but are concerned about possible memory decline in the future. For these individuals, a diagnostic evaluation provides a basis for comparison with future assessments.
What does a diagnostic evaluation include?
There is no single test that can provide all the information needed to make an accurate diagnosis for memory problems. A diagnostic evaluation, therefore, has many different potential components. It consists of a careful and detailed history of a person's current symptoms (onset and progression), his or her medical history, any current medications that may effect cognition, and a series of tests to assess various aspects of the current mental status. Several medical and neurological tests are also performed to help with the diagnosis by excluding conditions that may be causing or aggravating cognitive impairment.
A diagnostic evaluation generally includes the following components:
- Psychometric testing. Psychometric tests objectively measure cognitive performance the accuracy, speed, and quality of various aspects of mental processes. These include tests to assess functions such as immediate and delayed memory, attention, language, executive function, and problem solving.
- Neurological examination. A neurological examination assesses language, gait (how a person walks), coordination, reflexes, and sensory perception as they are affected by changes in brain function.
- A physical examination. A complete physical examination is performed and includes an electrocardiogram and blood and urine tests. These tests determine the presence or absence of conditions that may cause or aggravate memory deficits. Such conditions include thyroid conditions, vitamin 812 deficiency, electrolyte imbalances, high blood pressure, and heart arrhythmia (rhythm disturbances).
- A psychiatric evaluation. This part of the diagnostic evaluation involves assessments that focus on cognition (memory, concentration, and orientation) and how it affects a person's ability to function in daily activities. It also includes assessments focused on behavior and mood, which may cause memory problems, as well as information about the person's past medical and psychiatric history.
- An MRI or CT scan. An MRI or CT scan provides an image of the brain that helps in the diagnosis of Alzheimer's disease, Mild Cognitive Impairment, or age-related cognitive decline by ruling out such conditions as stroke, brain tumor, or hydrocephalus, all of which can cause cognitive impairment.
Once all the tests have been completed, and all laboratory results have been received, the information is reviewed and a diagnostic conclusion is reached.
Care and Treatment after the Diagnosis
A person who is experiencing age-related memory decline may notice a change in the condition over time. A person with dementia will experience changes in cognitive and functional abilities as the disease progresses. To ensure that Center of Excellence patients understand the change in their status over time the Center suggests diagnostic evaluations and follow-up assessments regularly, as well as ongoing telephone consultation as needed.
