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Health Care - Assessment and Testing

  • 1) Assessment and testing process
  • 2) Memory and thinking tests
  • 3) How to prepare for the assessment and testing process

1) Assessment and testing process

Assessment and testing for dementia may be frightening and overwhelming when you do not know what to expect. Below are some frequently asked questions that will hopefully give you a sense of what is involved in the assessment and testing process.

Frequently Asked Questions

How does a doctor diagnose dementia?
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The diagnosis is mainly clinical and no single test can provide an accurate conclusion. In fact, the diagnosis is mainly dependent on the kinds of symptoms presented, supported by the results of memory and thinking tests, laboratory, and possibly imaging tests(1).

Unlike other diseases, such as hypertension or diabetes, where there is an objective test for diagnosis, an accurate dementia diagnosis requires interpretation of many pieces of information. There are persons who score within "normal" limits of memory and thinking tests yet have a dementia, and others who score abnormally yet do not have a dementia. Clinicians will also take a thorough history of the symptoms that may include talking to a family member who may provide helpful information about function. For example, family members may be asked what the individual can do for him/herself, and what has the family partner in care had to take over, and why?

What assessment and testing will I undergo?
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It takes time to make a diagnosis. Several tests should be conducted to rule out other problems that may be contributing to your symptoms or the symptoms of your family member. Normally, the process will include:

  • A visit to your family doctor to present your concerns
  • A physical examination
  • Initial diagnostic testing
  • Detailed medical and medication history (including a detailed review of all current prescriptions, over the counter medications, vitamins, and herbal products)
  • Memory and skills tests such as the Clock-drawing Test, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA)
  • Mood and emotional assessment
  • X-rays and possible imaging studies such as Computerized Tomography (CT) scans, if necessary
  • A visit to a specialist such as neurologist, psychiatrist, geriatrician or family physician with training in memory disorders(1)

Why are many tests necessary?
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There are potentially several causes of memory or thinking problems, some of which can be easily fixed. These could include other medical conditions such as delirium, depression, metabolic causes, stroke, adverse drug effects, and other conditions(1). Additionally, different tests examine different parts of brain functioning. It is necessary to do a thorough and comprehensive assessment in order to produce an accurate diagnosis.

How long will the testing and assessment take?
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Due to the number of tests that are required, the assessment and testing process may be lengthy; however, the time it takes to receive a diagnosis varies widely(1). The time testing takes depends on what tests are administered and whether this is being done by a family doctor in his/her office, in a primary care memory clinic (memory clinic that operates within a health care centre, and provides routine outpatient care - generally is the first contact with the health care system)(2), or a tertiary care memory clinic (health care centre that has highly trained specialists and often advanced technology)(2).

Some family doctors may do brief screening tests which takes 10 to 20 minutes. The Montreal Cognitive Assessment (MoCA) usually takes 10 minutes. A large amount of additional time, however, is spent on taking a detailed medical history from the individual and from a family member. This could take a couple of hours and may also include a multidisciplinary assessment including a social work interview and pharmacists' drug review in some cases. In tertiary care settings, visits can take a half day and might include other types of multidisciplinary assessment and specialist assessment as well. It varies widely and it may take repeated visits before a diagnosis is made. It is important to note that no one test alone is adequate or acceptable in diagnosis dementia.

Why is it important to be assessed?
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The testing and assessment process may provide the first opportunity to openly discuss the possibility of a diagnosis. It is important that assessment and testing not be delayed, as it prevents delay in establishing a diagnosis and options for treatment. Testing and comprehensive evaluation leads to accurate diagnosis and discussion of treatment, enabling greater control in your life by providing choices based on knowledge and understanding and opportunities to plan ahead.

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Sources:

The information above comes from the following source(s):

(1) Murray Alzheimer Research and Education Program. (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

(2) The Free Dictionary. Retrieved November 22, 2011 from http://medical-dictionary.thefreedictionary.com/Tertiary+care.

Helpful Links and Resources

Title of Resource What it Offers? Access to the Resource
Before/early diagnosis – A By Us For Us Guide An inspirational guide for partners in care of people living with memory loss.

Contact MAREP:

519-888-4567x35040

Alzheimer Society of Canada website Information on getting a diagnosis http://www.alzheimer.ca/en/About-dementia/Diagnosis

2) Memory and thinking tests

Although there are several components to providing an accurate diagnosis, the following questions are specific to the assessment of cognitive abilities.

Frequently Asked Questions

What is the Montreal Cognitive Assessment (MoCA)?
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The Montreal Cognitive Assessment (MoCA) is a 10 minute screening tool for mild cognitive impairment and dementia. The tool assesses different areas of brain function (attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation) through a series of activities that are completed both verbally and with paper and pen. The individual is given a score out of 30; a score of 26 or above is considered normal(1), although persons scoring above 26 may still have cognitive impairment and those scoring below 26 may not. The interpretation of the score depends on the symptoms and other findings in the assessment.

What is the clock-drawing test?
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The clock-drawing test is used as a quick screening test (1-2 minutes) for cognitive dysfunction. It requires the person to draw the face of a clock, and position the numbers and hands to represent a time given by the assessor. The tool considers cognitive, motor and perceptual functions. When a person has significant challenges in producing a clock, this can indicate potential problems requiring further examination(2).

What is the Mini-mental state examination (MMSE)?
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The original Mini-mental state examination (MMSE) and its newer versions are used as a screening test for dementia and cognitive functioning. The tool assesses orientation to time and place, immediate recall, short-term verbal memory, calculation, language, and construct ability, through a series of verbal and paper and pencil activities. Depending on the version being used, the test can take up to 20 minutes to administer. The individual is given a score out of 30; a score above 25 is considered normal although persons scoring above 26 may still have cognitive challenges and those scoring below 26 may not. The interpretation of the score depends on the symptoms and other findings in the assessment(3).

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Sources:

The information above comes from the following source(s):

(1) Nasreddine, Z. (2010). Montreal Cognitive Assessment (MoCA) - Administration and Scoring Instructions. Retrieved from www.mocatest.org.

(2) Braunberger, P. (2001). The clock-drawing test. Retrieved from http://www.neurosurvival.ca/ClinicalAssistant/scales/clock_drawing_test.htm.

(3) Mini–mental state examination. (2011, April 24). In Wikipedia, the free encyclopedia. Retrieved October 18, 2011, from http://en.wikipedia.org/wiki/Mini-mental_state_examination.

3) How to prepare for the assessment and testing process

While waiting for an appointment with the specialist or memory clinic for assessment and testing, develop a plan. Persons awaiting assessment and testing benefit from keeping intellectually stimulated, eating a nutritious diet, exercising regularly, keeping active socially, and finding ways to cope with and reduce stress levels. The following is a list of frequently ask questions to help you prepare(1).

Frequently Asked Questions

How should I prepare myself for the testing and assessment process?
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It is best to ask your doctor or specialist how to prepare for testing day. Some strategies include:

  • Being well rested
  • Bring a family member or friend who knows you well
  • Bring in all your medication (including herbal, supplements, vitamins, eye drops, inhalers, prescription, and non-prescription medication)
  • Bring all of your assistive devices (including eyeglasses, contact lenses, dentures, hearing aids, canes, walkers)
  • Dressing comfortably and being prepared for a lengthy visit of up to 3 hours
  • Be prepared with questions to ask your physician or specialist(1)

What questions should I ask the doctor or specialist before testing?
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Some questions you may want to ask before assessment begins, include (Questions for doctor PDF):

  • What is involved in the process of making a diagnosis of dementia?
  • What tests do I need to have done and where will they take place?
  • What other disease(s) are you trying to eliminate in the testing process?
  • What else could these symptoms signify?(1)
  • How should I prepare for my assessment?

What questions should I ask the doctor or specialist upon diagnosis?
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After you have undergone testing and assessment, your doctor will discuss the results with you. Some questions you and your family member might want to ask after receiving a diagnosis include (Questions for doctor PDF):

  • Can you explain this diagnosis to us please?
  • What do we do now?
  • What does this mean to me as the person with dementia? What does this mean for my family members/partners in care?
  • What can we expect?
  • What medications or treatments are available?
  • What resources are available to help us?
  • What is the follow-up process?(1)
  • Do you know of any current clinical drug trials that I can participate in?

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Source:

The information above comes from the following source(s):

(1) Murray Alzheimer Research and Education Program. (2011). Before/early diagnosis: An inspirational guide for partners in care of people living with memory loss. A "By Us For Us" Guide. Waterloo, Ontario: MAREP.

Helpful Links and Resources

Title of Resource What it Offers? Access to the Resource
Preparing for your doctor's visit A checklist to prepare you for your visit to the doctor http://www.alzheimer.ca/en/About-dementia/Diagnosis/ Getting-a-diagnosis/~/media/Files/national/pdfs/English/Brochures/AS12_Preparingforyourdoctor_EN_FINAL.ashx
Alzheimer Society of Canada website Clinical trials and research studies recruiting in Canada http://www.alzheimer.ca/en/Living-with-dementia/Treatment-options/How-drugs-are-approved-in-Canada
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[This page updated on February 3, 2014]
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