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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Working With A Health Care Professional


June 28, 2013

Reviewed by the Faculty of Harvard Medical School

 
When you see a doctor or other health care professional, he or she will take a full medical history and conduct a thorough examination.
 
Your health care professional will want to know when your memory problems started and how quickly they progressed. This information, together with your age and other medical history, can point toward a likely diagnosis. For example:
  • If you are elderly and have had consistently worsening memory and other cognitive problems for several years, Alzheimer's disease may be suspected.
  • If you have had a history of high blood pressure, diabetes and vascular disease, then multi-infarct dementia may be suspected.
  • If the progression of your memory loss has been extremely rapid, then Creutzfeldt-Jakob disease may be suspected.
Your health-care professional will also want to know about your general health, diet, any past illnesses, medications (including over-the-counter medications) and social circumstances. You may find it helpful to take a close relative or a friend with you when you see a health-care professional. Your relative or friend may be able to provide further information if there is something you can't remember.
It is also helpful to make a few notes to take along when you see a health care professional. Here are a few examples of what to write down in the days leading to your appointment:
  • Memory, cognitive or behavioral problems that you or others have noticed
  • A list of the medications you take (when possible, bring the pill bottles)
  • An outline of your medical history
  • Any concerns or queries you may have

 

Confirming The Diagnosis
A diagnosis of dementia is made if you have progressive memory loss and at least one of the following:
  • Loss of language — difficulty either understanding or using language
  • Apraxia — the inability to perform a purposeful act or sequence of motor activities
  • Agnosia — the inability to recognize familiar objects or people
  • Disturbance in higher-level functioning — difficulty doing such things as planning or organizing
You may also undergo cognitive function tests that measure memory and attention span. A commonly used screening test is called the Mini Mental State Exam which consists of about 30 questions and takes about 10 minutes to complete. Based on the number of correct answers, the score helps predict the presence of dementia and its severity.
Your doctor may order routine blood tests such as B12 and thyroid hormone level to rule out possible reversible causes of memory loss.
Other possible tests include:
  • Magnetic resonance imaging (MRI) or computed tomography (CT) — An MRI takes pictures of structures inside the body (similar to the way X-rays create images of bones). It is a painless test, requiring only that you lay still. The results of MRI help diagnose or rule out brain tumors and stroke. The absence of any structural abnormalities in the brain supports a diagnosis of Alzheimer's disease, which depends more on brain function than on brain structure.
  • Lumbar puncture (spinal tap) — This test is used only in rare cases. A lumbar puncture samples cerebrospinal fluid and is used to diagnose a central nervous system infection. It will also detect elevated fluid pressure in and around the brain.
Your doctor may refer you to a specialist in cognition and memory. Psychiatrists, neurologists and neuropsychologists are all qualified to evaluate brain function. The specialist will administer a series of written tests and verbal exercises. How you perform on these tests will help identify memory, language and visual function, as well as overall brain function.

 

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