• What is a Diagnostic Evaluation for Memory Impairment?
• What does a diagnostic evaluation include?
• Receiving the Diagnosis
• Care and Treatment After the Diagnosis

What is a Diagnostic Evaluation for Memory Impairment?

For individuals experiencing memory problems, a comprehensive diagnostic evaluation is the first step toward determining the nature and significance of the problem, and toward getting the right care. Memory problems can result from many different medical conditions, including Alzheimer's disease and Mild Cognitive Impairment, or they can be a result of normal aging, (age-related cognitive decline). A diagnostic evaluation is the only way healthcare providers can assess a person's condition and provide an accurate diagnosis. The diagnosis then determines appropriate treatment and care options, as well as an accurate forecast of the course of the problem (what doctors call a prognosis).

A diagnostic evaluation can also provide reassurance for aging individuals who are not currently experiencing symptoms, but are concerned about possible memory decline in the future. For these individuals, a diagnostic evaluation provides a basis for comparison with future assessments.

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What does a diagnostic evaluation include?

There is no single test that can provide all the information needed to make an accurate diagnosis for memory problems. A diagnostic evaluation, therefore, has many different components. It consists of a careful and detailed history of a person's current symptoms (onset and progression), their medical history, any current medications that may effect cognition (memory, concentration and orientation), and a series of tests to assess various aspects of a person's current mental status. Several medical and neurological tests are also performed to help with the diagnosis by excluding conditions that may be causing or aggravating cognitive impairment.

A diagnostic evaluation generally includes the following components:

A psychiatric evaluation. This part of the diagnostic evaluation involves assessments that focus on cognition (memory, concentration, and orientation), and how it affects a person's ability to function in daily activities. It also includes assessments focused on behavior and mood, which may cause memory problems, as well as information about the participant's past medical and psychiatric history.

Psychometric testing. Psychometric tests objectively measure cognitive performance - the accuracy, speed and quality of various aspects of mental processes. These include tests to assess functions such as immediate and delayed memory, attention, language, executive function and problem solving.

A neurological examination. A neurological examination assesses language, gait (how a person walks), coordination, reflexes and sensory perception as they are affected by changes in brain function.

A physical examination. A complete physical examination is performed and includes an electrocardiogram, and blood and urine tests. These tests determine the presence or absence of conditions that may be related to (causing or aggravating) memory deficits. Such conditions include thyroid conditions, vitamin B12 deficiency, electrolyte imbalances, high blood pressure, and heart arrhythmia (rhythm disturbances).

An MRI or CT scan. An MRI or CT scan provides an image of the brain that helps in the diagnosis of Alzheimer's disease, Mild Cognitive Impairment or age-related cognitive decline by ruling out such conditions as stroke, brain tumor or hydrocephalus, all of which can cause cognitive impairment.

Once all the tests have been completed and all laboratory results have been received, they are reviewed and discussed in a clinical staff meeting, called clinical rounds, where the final diagnosis is made.

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Receiving the Diagnosis

At the NYU Alzheimer’s Disease Center, participants receive their diagnosis at a special meeting called the Family Conference. The Family Conference is a time for participants and their families to receive an explanation of the testing results and to ask questions, and discuss concerns about care and treatment. Participants and their families are invited to first meet with a physician or psychologist who reports the diagnosis and discusses with them the results of individual tests. The physician or psychologist also discusses recommendations for further medical treatment, and suggests any ADC clinical trials and research programs, as appropriate.

Participants and their families then meet with a counselor to talk about their concerns and to determine care needs based on the participant's diagnosis. Suggestions may be made about appropriate home care options, emotional and social support, resources for financial and legal issues, and a range of other services and care options as needed.

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Care and Treatment After the Diagnosis

A person who is experiencing age-related memory decline may notice a change in their condition over time. A person with Alzheimer's disease will experience changes in cognitive and functional abilities as the disease progresses. The recommendations that NYU ADC clinicians and counselors make at the Family Conference are based on a participant's most recent diagnostic evaluation. To ensure that ADC participants have an accurate understanding of their condition over time, the NYU Alzheimer’s Disease Center offers diagnostic evaluations and follow up assessments every two years, as well as on-going telephone consultation as needed.