The only certain diagnosis is during an autopsy.  Usually the tests will
rule out anything that is treatable, then when they are ruled out, AD is
what is left.

My mother was given a bunch of tests to rule out any organic cause.  I can't
remember all the test because it's been quite a few years but a few of them
were blood, urine, EEG, scan to rule out strokes, etc.  They were concerned
with vitamin levels with the bloodwork.  She was also given memory tests by
the neurologist.  After all that, she was diagnosed with mild to moderate
Alzheimer's.

Camille

Hi,

In the instance of my mother in law's diagnosis, for some time we knew
something wasn't quite right, and we noticed she had been neglecting her
business matters (as well as her personal hygiene) so she didn't even have
an assigned PCP anymore, through her insurance.

We had to get her established with a new PCP and asked for a complete
gerontological workup, (which we personally took her to all appointments).
She also had neglected her hearing aid which needed service, as well as her
teeth, which she had formerly been VERY meticulous about.   All these
appointments and arrangements took a lot of time since we lived two hours
away and it was quite a hassle, but it had to be done.

After we got the hearing aid functioning and the more urgent teeth issues
taken care of, and establishing her with the new PCP, they gave her a blood
test to establish thyroid levels, a CAT scan to determine the size and
volume of certain brain areas, and a test by a psychiatrist which was a
question and answer thing, consisting of simple questions and requests to
perform certain sequential actions.   They also did a test to establish that
she had proper blood flow to the brain.   I think it was an ultrasound test,
but I don't really remember exactly what.

There are many who have also reported their loved ones were tested by being
asked to draw clock faces and to count backwards from 100 by certain
numbers.   My mother in law's deficits were revealed very clearly in that
she absolutely could not perform a simple sequence..... such as:   "take
this sheet of paper, fold it in half, then in quarters, then place it here
on my desk"   She instead took the paper, folded it in half and then stood
there holding it, not knowing what to do with it next.

Upon testing her deficits became very clear, even to us.   The PCP called us
in and told us that she really should not be living alone anymore.   It
wasn't easy to pursuade her to leave her home.   She had always been a
fiercely independent and strong person, and my husband was her only child.
She was determined not to become a burden and to remain alone as long as
possible.   Finally it became absolutely necessary to remove her from her
home under the ruse that it was a visit for a short time.   That short time
evolved into several years and I think she was very happy here living with
us.   She gained back the weight she had lost and was happy, clean, healthy
and no worries for a long time.   We were very lucky to have a good doctor
locally (only 1/2 mile down the road) who treated her throughout that whole
time, adjusting her medications according to her needs carefully as we went
along.

Ultimately she had to be placed in a nursing home last May, because she grew
more and more unsteady on her feet and kept falling.    She truly needed
full time nursing care at that point.   She is in a lovely place very close
to our home and we see her often.   She has adjusted to the routine and the
people very well.

There is no typical story, but this could be one scenario of a typical
story.....

The usual drill is to start with a full physical including a review of
medical history AND all medications the person is on. What they are
looking for are any conditions that can cause confusion, memory loss,
fuzzy thinking etc. OTHER than Alzheimer's and other incurable
progressive dementias. After all, in an older person who may have a
constellation of medical issues, problems can brew and fly under the
detection radar due to the distraction of other medical concerns i.e.
the doctor is so focussed on the diabetes and the heart problem that
the brewing thyroid issue goes undetected. It can also happen that a
person is seeing a number of specialists and no one really knows ALL
the medications someone is taking - and interactions can be causing
problems. A good physical should also involve blood tests for thiubngs
like pernicious anemia and thyroid function.

Once the obvious non-AD things are ruled out, the next step is usually
a referral to a neurologist or psychiatrist with a speciality in
dementias. Once there, its common to have a number of other tests,
such as various kinds of head scans. At the same time, my MIL also had
a comprehensive assessment of her deficits - they wanted to know
exactly how impaired she was, but also in what areas, since different
causes of dementia can cause completely different sets of deficits -
and the resulting deficits result in characteristic behaviour
patterns.

Essentially, AD is only diagnosed by ruling out everything else it can
be, because although they are getting closer with various kinds of
scans, the only way to be 100% sure would be a brain biopsy, rarely
done for obvious reasons!

Just to give you an idea of what they are looking for and trying to
rule out, here is a list of things that can cause dementia, or
dementia like issues (and its not a complete list, just some of the
biggies!)

Degenerative

Alzheimer's Disease
Parkinson's Disease
Dementia with Lewy Bodies
Progressive Supranuclear Palsy
Multiple System Atrophy
Huntington's Disease
Pick's Disease
Frontotemporal (chromosome 17) Dementia
Corticobasal Ganglionic Degeneration
The Parkinsonian Dementia Complex of Guam
Dementia Lacking Distinctive Histological Features

Vascular

Multiple Infarction Dementia
Strategic Infarction Dementia
Lacunar State
Binswanger's Disease (Subcortical Ischemic Encephalopathy)
Vasculitis
Subarachnoid Hemorrhage

Infection

Fungal Meningitis
Syphilis
AIDS Dementia
Creutzfeldt-Jacob Disease (and other Prion diseases)
Post Herpes Simplex Encephalitis

Psychiatric

Depression
Alcohol abuse
Drug use or abuse (or interactions/side effects)
Personality Disorder
Anxiety Disorder

Toxic/Metabolic

B12 deficiency
Thyroid deficiency
System failure including liver, renal, cardiac, respiratory
Heavy metal toxicity
Toxin exposure e.g. glue sniffing

Trauma

Subdural hematoma
Closed head injury
Open head injury
Pugilistic brain injury
Anoxic brain injury

Tumor

Glioblastoma
Lymphoma
Metastatic tumor

Other

Symptomatic Hydrocephalus (Normal Pressure Hydrocephalus)

Hope this helps

Mary G.

it's a very good thing that she's had the MRI, if not much else... a friend
of mine's husband just had a brain tumor removed and is now undergoing
radiation ... after 2+ years of being treated for AD