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Consulting the Doctor

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By Report by the Agency for Hlth Care Pol & Research • • September 1, 1996

Identifying mild cases of Alzheimer's disease can be very difficult. Your doctor will review your health and mental status, both past and present. Changes from your previous, usual mental and physical functioning are especially important.
Persons with Alzheimer's disease may not realize the severity of their condition. Your doctor will probably want to talk with family members or a close friend about their impressions of your condition.
The doctors first assessment for Alzheimer's disease should include a focused history, a physical examination, a functional status assessment, and a mental status assessment.
Medical and Family History
Questions the doctor may ask in taking your history include: How and when did problems begin? Have the symptoms progressed in steps or worsened steadily? Do they vary from day to day? How long have they lasted?
Your doctor will ask about past and current medical problems and whether other family members have had Alzheimer's disease or another form of dementia.
Education and other cultural factors can make a difference in how you will do on mental ability tests. Language problems (for example, difficulty speaking English) can cause misunderstanding. Be sure to tell the doctor about any language problems that could affect your test results.
It is important to tell the doctor about all the drugs you take and how long you have been taking them. Drug reactions can cause dementia. Bring all medication bottles and pills to the appointment with your doctor.
Do you take any medications? Even over-the-counter drugs, eye drops, and alcohol can cause a decline in mental ability. Tell your doctor about all the drugs you take. Ask if the drugs are safe when taken together.
Physical Examination
A physical examination can determine whether medical problems may be causing symptoms of dementia. This is important because prompt treatment may relieve some symptoms.
Functional Status Assessment
The doctor may ask you questions about your ability to live alone. Sometimes, a family member or close friend may be asked how well you can do activities like these:
? Write checks, pay bills, or balance a checkbook.
? Shop alone for clothing, food, and household needs.
? Play a game of skill or work on a hobby.
? Heat water, make coffee, and turn off stove.
? Pay attention to, understand, and discuss a TV show, book, or magazine.
? Remember appointments, family occasions, holidays, and medications.
? Travel out of the neighborhood, drive, or use public transportation.
Sometimes a family member or friend is not available to answer such questions. Then, the doctor may ask you to perform a series of tasks ("performance testing").
Mental Status Assessment
Several other tests may be used to assess your mental status. These tests usually have only a few simple questions. They test mental functioning, including orientation, attention, memory, and language skills. Age, educational level, and cultural influences may affect how you perform on mental status tests. Your doctor will consider these factors in interpreting test results.
Alzheimer's disease affects two major types of abilities:
1. The ability to carry out everyday activities such as bathing, dressing, using the toilet, eating, and walking.
2. The ability to perform more complex tasks such as using the telephone, managing finances, driving a car, planning meals, and working in a job.
When a person has Alzheimer's disease, problems with complex tasks appear first and over time progress to more simple activities.
Treatable Causes of Dementia
Sometimes the physical examination reveals a condition that can be treated. Symptoms may respond to early treatment when they are caused by:
? Medication (including over-the-counter drugs).
? Alcohol.
? Delirium.
? Depression.
? Tumors.
? Problems with the heart, lungs, or blood vessels.
? Metabolic disorders (such as thyroid problems).
? Head injury.
? Infection.
? Vision or hearing problems.
Drug reactions are the most common cause of treatable symptoms. Older persons may have reactions when they take certain medications. Some medications should not be taken together. Sometimes, adjusting the dose can improve symptoms.
Delirium and depression may be mistaken for or occur with Alzheimer's disease. These conditions require prompt treatment. See the inside front cover of this booklet for more information on delirium and depression.
Special Tests
Gathering as much information as possible will help your doctor diagnose early Alzheimer's disease while the condition is mild. You may be referred to other specialists for further testing. Some special tests can show a persons mental strengths and weaknesses and detect differences between mild, moderate, and severe impairment. Tests also can tell the difference between changes due to normal aging and those caused by Alzheimer's disease.
If you go to a special doctor for these tests, he or she should return all test results to your regular family doctor. The results will help your doctor track the progress of your condition, prescribe treatment, and monitor treatment effects.

Source: Agency for Health Care Policy and Research(AHCPR)
Publication No. 96-0704
Clinical Practice Guideline, Number 19, Consumer Version
September 1996

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