Diagnosing Alzheimer's: Physical & Neurological Exams
When a person is having memory problems or when Alzheimer’s disease is suspected in a patient, doctors use a variety of tools to help them narrow down the diagnoses. The only way to definitively diagnose Alzheimer’s disease is on autopsy, so doctors perform multiple tests and exams to rule out other possible causes of the presenting symptoms.1 It’s important to get an accurate diagnosis, since many other ailments and complications can cause symptoms similar to those of Alzheimer’s. In addition to taking a full medical and symptom history, the provider will also conduct physical and neurological exams, as well as other tests.
The physical exam will be similar to a regular physical exam that is typically done at a doctor’s appointment. The doctor will assess for any possible conditions that could be causing the symptoms, like stroke, excessive alcohol use, sleep apnea or other disturbances, infection, medication side effects or interactions, tumors, or heart disease.1,2 They will observe the patient for any signs of difficulty speaking, hearing, moving, or understanding.
Neurological exams look for signs of brain disorders, and can be very helpful in aiding in a diagnosis of Alzheimer’s disease. A general neurological exam can look for stroke, Parkinson’s disease, brain tumors, fluid accumulation on the brain, and a variety of illnesses that can cause memory or cognitive disorders.3 The physician will test reflexes, eye movements, speech, coordination and muscle tone/strength, and sensitivity and sensation.3 More specific neurological exams can include questionnaires that family members and close friends fill out, like the AD8 (Eight-item Informant Interview to Differentiate Aging and Dementia) or the IQCODE (Short Informant Questionnaire on Cognitive Decline in the Elderly), or various exams that the practitioner administers directly to the patient.4
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.5
The Mini-Cog is a test that only takes three minutes to help a doctor determine whether there is any cognitive impairment in older adults. There is a recall test for memory and a clock drawing test. It should not be used as a complete diagnostic test, but merely a screening tool.6
Another neurological test that can be performed is the General Practitioner Assessment of Cognition (GPCOG). This is a screening tool for dementia that is tailored to the primary care setting. It takes four minutes to interview the patient, and two minutes for a caregiver interview.7 This makes it easy to do as part of a larger exam, and can provide information for further testing or other types of tests that may be necessary.
Depending on the symptom presentation and severity of symptoms, the doctor might choose to do one of the previously mentioned neurological exams, a different neurological exam, a battery of neuropsychological exams, and/or refer the patient to a specialist. The neurological exam cannot diagnose Alzheimer’s disease, but it can provide the physician or treatment team with information about the neurological status of the person and help guide any further testing or evaluation.