Understanding Dementia Neurological Assessments: How Doctors Diagnose Cognitive Impairment

If you start to experience difficulties with memory and attention as an older adult, you may be concerned about the possibility of dementia. Seeing a doctor for an examination may be a logical next step, but what will this process look like? 

A dementia exam usually involves various cognitive function tests, such as asking the patient to name specific objects, remember sequences of words, or solve problems and puzzles. A comprehensive physical examination is also typically required for a diagnosis, along with a thorough medical history review. Interviews with friends and family can offer additional insights into the patient’s recent mental status. Once a diagnosis has been established, treatment can begin. This typically involves a combination of medication, therapy, and lifestyle adjustments.

Are you experiencing stress related to your cognitive health?

Consult with a mental health professional

Understanding dementia and the value of seeking a dementia diagnosis

The idea of developing dementia can be frightening, and many people prefer to avoid thinking about it until they must. However, if you believe you could be at risk for one of the neurodegenerative disorders responsible for this type of illness, seeking a diagnosis as soon as possible may benefit you in the long run. 

While dementia is currently incurable, a variety of therapies may slow its progression. This can include mentally enriching activities intended to build up your “cognitive reserve” by expanding the network of neural connections inside your brain. 

Certain experimental medications may also be able to delay the deterioration of brain tissue that causes dementia symptoms. 

Early detection of Alzheimer’s disease, vascular dementia, and other types of dementia

These types of preventative treatments may be considerably more effective during the early stages of dementia. Getting a neurological examination to assess your cognitive health may increase the chances that you can take action while there’s still time.

In addition, the early detection of dementia can give you time to make arrangements for your future care and comfort. Whether it’s Alzheimer’s, vascular dementia, or Parkinson’s disease, spotting the early signs can help both the patient and the caregiver understand the neurodegenerative disease. You can start saving money, researching treatment providers, and looking for accommodations that may enable you to live independently for as long as possible. Taking these actions sooner rather than later could improve your quality of life in the long run. 

How clinicians diagnose dementia

A diagnostic examination for dementia will typically involve a variety of components, including interviews, tests, and observational assessments. Some of them may seem unrelated to your cognitive health, but ruling out other illnesses may be necessary for an accurate diagnosis. 

Understanding dementia’s neurological assessment

Here’s what you can expect from a neurological assessment for dementia.

Discussion of your medical history

Your doctor will likely begin by asking about any past or current illnesses, prescriptions, and other potentially medically relevant factors. In many cases, your medical history can go a long way toward establishing a diagnosis.

Any potential dementia symptoms, such as forgetfulness, getting lost, or struggling to find words, may clarify your cognitive status. You may also discuss potential risk factors for dementia, such as the following:

• A family history of Alzheimer’s disease
• Smoking, excessive drinking, or other unhealthy substance use
• Health problems like diabetes or heart disease

You may also want to bring a trusted friend or relative who can speak about your mental status. Talking to family members and loved ones can help your physician learn about changes in your thinking and behavior of which you may not be aware. 

The doctor may also ask about any recent life stressors, mood changes, and emotional regulation challenges. These questions could rule out the presence of a mental health condition like depression that could be affecting your cognitive abilities.

Physical exam

Additional warning signs or risk factors may arise during a physical examination. A physician examining you for dementia will likely test your vital signs, looking for indicators like high blood pressure and heartbeat irregularities that could suggest the presence of vascular dementia. You’ll likely be tested for reflexes and motor control as well, which can help identify medical issues like a stroke or concussion. 

Blood tests may rule out factors like thyroid disease, infections, and heavy metal toxicology that can mimic symptoms of dementia. Some emerging diagnostic measures may be able to detect biomarkers of certain forms of dementia in the blood, such as elevated levels of the peptide amyloid-beta (a common feature of Alzheimer’s disease).

Brain imaging

Your doctor might order brain scans, including magnetic resonance imaging (MRI) or positron emission tomography (PET) scans. These tools may detect dementia markers — for example, protein plaques building up around neurons, as are frequently observed in Alzheimer’s disease. Alternatively, a scan might reveal factors like brain injuries that could explain your symptoms better than dementia.

Understand dementia better: Tests of cognitive function for dementia

Another way doctors commonly test for dementia is by administering various tests of cognitive capability. 

Clinical trials have found that many of these assessment tools can detect dementia with high specificity and sensitivity. They’re usually not diagnostically definitive on their own, but in combination with the other measures described above, they can confirm the presence of neurocognitive disorders. 

Some commonly used evaluative tools include the following:

• Montreal Cognitive Assessment (MoCA): Usually administered in under 10 minutes, the MoCA is a written test of various functions of abstract thought and visuospatial function.
• Ascertain Dementia 8-Item Questionnaire (AD-8): This brief questionnaire asks about recent changes in mental acuity and can be completed by either the patient or an informant who knows them well. Having a third party complete the form may improve its accuracy.
• Mini-Mental State Exam (MMSE): The MMSE involves a series of tasks testing mental function. The speed with which a patient completes it can help determine whether they’re cognitively impaired. 
• Frontal Assessment Battery (FAB): This series of short tests can assess executive function (behavioral control) and help diagnose brain disorders affecting this ability, such as frontotemporal dementia.
• Mini-Cog: The Mini-Cog is a brief verbal exam combined with a drawing exercise that can detect the types of cognitive impairments characteristic of dementia. 
• Addenbrooke’s Cognitive Examination-Revised (ACE-R): Designed to expand on the MMSE, the ACE-R assessment tests five cognitive domains: memory, language, visuospatial awareness, speech production, and attention. A 2015 research review concluded that the ACE-R is one of the most accurate cognitive exams for dementia diagnosis. 

How do cognitive assessments test for dementia?

The cognitive function tests described above are typically designed to test specific mental skills commonly affected by dementia. No two assessments are exactly the same, but they often involve challenges like those discussed below.

Temporal and spatial orientation tests

Almost all neurological assessments for dementia involve questioning the patient about the current day, month, and year, along with their current location, including the city, state, and country. Poor orientation in space and time can be a sign of dementia.

Word recall tests

To assess the patient’s working memory, the examiner usually recites a specific list of words and asks the patient to repeat them back. Some studies suggest this may be the most accurate diagnostic measure for mild cognitive impairment (MCI), a common precursor to dementia.

Naming tests

Many kinds of dementia affect the patient’s vocabulary and verbal fluency. Assessments like the Boston Naming Test can help identify these conditions by asking the individual to give the correct names for a series of images of specific objects.

Attention tests

Patients may be asked to pick out a specific letter or number from a long string, recite a particular sequence of numbers forward and then backward, or perform other tasks requiring sustained focus and attention to detail.

Drawing tests

Another cognitive assessment task can be drawing common objects, simple shapes, or entries in a specific category. The clock test is a frequently used example in which the person must draw an analog clock face with the hands set to a particular time. Different types of dementia tend to cause different errors in this task, making it useful for identifying a patient’s specific pathology. 

Are you experiencing stress related to your cognitive health?

Consult with a mental health professional

What if a neurological test suggests you might have dementia?

If you’ve undergone a neurological assessment and the results suggest you may be cognitively impaired, there may be steps you can take to improve your prognosis. Mild cognitive impairment may not always result in full-fledged dementia, and some degree of mental function can sometimes be regained. You may be able to protect your cognitive health by adopting healthy habits like the following:

• Exercising regularly
• Quitting smoking
• Eating nutrient-rich foods
• Maintaining a healthy sleep schedule
• Engaging in mentally stimulating activities

Understanding dementia and treating conditions that can worsen symptoms through online therapy

You may also benefit from talking with a mental health professional who can help you plan for future treatment while combating depression and other conditions that can worsen dementia symptoms. Online therapy may be a helpful option if you’re unsure about how to fit counseling into your schedule. Internet-based care typically requires no commute and often allows for more scheduling flexibility. 

Effectiveness of online therapy for mental health challenges experienced by people with dementia

An increasing number of studies demonstrate that online mental health care can be an effective treatment for depression and other mental health challenges common in people with dementia. Internet-based treatments are often equally effective to traditional therapy in head-to-head trials, with both usually producing robust improvements in symptoms.