Diagnosing Alzheimer's: Mental Status & Mood Tests

Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: January 2021

Diagnosing Alzheimer’s disease isn’t easy. Physicians and treatment teams use a variety of tests and exams to help rule out illnesses and determine the underlying causes of the presenting symptoms. A definitive Alzheimer's diagnosis is only able to be done on autopsy, so it’s important to use all possible screening and assessment tools to ensure that the diagnosis is as accurate as possible.1

In addition to talking about medical and symptom history with your doctor, your doctor may also do a physical exam, various neurological exams, and mental status and mood testing. This helps provide valuable information to the doctor in order for them to make an informed, accurate diagnosis.

Mental status testing

Mental status testing involves tests used to evaluate cognition, or thinking, as well as memory skills. They help to measure cognitive impairment and overall awareness, like whether the patient is aware of their symptoms, oriented to time and place, and short-term memory capabilities. There are a variety of tests that can be used, but perhaps the most well-known and widely used one is the Mini-Mental State Exam (MMSE). The MMSE consists of a series of questions that are administered by a health care professional that test everyday mental skills.2 Out of 30 points, the score can reflect varying levels of cognitive impairment. Some physicians also use computer-based tests, but this can vary, depending on the level of impairment. Using both can be helpful for the physician to see how the person responds to different modes of testing, as well.

The Montreal Cognitive Assessment (MoCA) is a 30-question screening tool used to assess for cognitive impairment. While it is similar to an older test, the Mini-Mental Status Exam (MMSE), the MoCA is better able to screen for cognitive impairment, especially mild cognitive impairment.3

The MoCA tests for different aspects of cognitive skills, including orientation to time, place, and day; short-term memory; executive functioning; language abilities; attention; and abstract thinking. All of these sub-categories of cognitive functioning can provide practitioners with valuable information about whether cognitive impairment is present, and to what degree.

While the MoCA provides detailed information about a person's cognitive functioning, it should not be the only test used, but rather be part of a thorough diagnostic workup. If cognitive changes are suspected, people will likely receive further testing administered by a neuropsychologist to diagnose more specifically the categories of cognition that are most impaired. These tests help distinguish Alzheimer’s disease from other causes of cognitive impairments. However, no test can perfectly diagnose the type of neurodegenerative disorder. Current research is focused on imaging and biomarker tests to help make a more definitive diagnosis.

Mood testing

While mood testing might seem like a surprising part of an assessment for Alzheimer’s, it’s an important part of the assessment and diagnostic process for Alzheimer’s disease. Even prior to any cognitive impairment, it is thought that symptoms of mood disorders may be present in patients with Alzheimer’s disease, especially symptoms like depression and apathy.4 These mood symptoms can affect at least half of all people with Alzheimer’s disease. These mood symptoms are suspected to be part of the initial phase of the disease, rather than an effect of the disease.3 One such test that might be used is the AD-RD Mood Scale (Alzheimer’s Disease-Related Dementias Mood Scale).5

If a person does not have Alzheimer’s disease or a related cognitive disorder, sometimes mood disorders can be severe enough to impair memory. For that reason, mood testing can be a way to rule out severe mood disorders that might be presenting as cognitive impairment. Once the underlying cause is found, appropriate treatment can be started.

Depending on the results of the mental status exam and mood testing, further testing might be recommended, or the patient might be referred to a doctor who specializes in memory disorders or cognitive impairment. Although it might be frustrating to undergo a variety of tests, all of the different kinds of tests have their purpose.

Alzheimer’s disease affects a wide range of functioning, and because so many other ailments and complications can cause similar symptoms, getting an accurate diagnosis is of the utmost importance. Diagnosis guides treatment, and so an accurate diagnosis from the start is crucial.

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