The large number of causes of dementia, as well as the similarity of the symptoms from one cause to another, can make diagnosis and treatment of dementia very difficult. Sometimes the diagnosis is made only after the person has died, and the brain tissue is examined during an autopsy. With all kinds of dementia, however, early diagnosis is very important, for several reasons. It may be that the person's symptoms are caused by something that is treatable, in which case they may be reversible. Even if the cause is found to be something that is irreversible, prompt treatment of the symptoms can help slow their progression. Early diagnosis of an irreversible disease also gives the person the chance to manage his symptoms better and help plan for his future while he is still able to think clearly and make decisions about his own care. Because early diagnosis is so critical, it is very important for the person with early dementia symptoms to seek medical care as soon as possible.

For a number of reasons, people with dementia symptoms sometimes delay seeking medical care. They and their families may be unwilling to think about the possibility that they could be facing this kind of disease, with a rather grim future ahead. Dr. Eric Tangalos of the Mayo Clinic says, "There remains a tremendous anxiety regarding Alzheimer's".

People with dementia symptoms and their families are often reluctant to pursue medical care out of fear or denial, knowing that an official diagnosis brings the certainty of a long, slow decline.

Sometimes doctors themselves are reluctant to make a diagnosis of dementia. Many doctors still believe that an early diagnosis of Alzheimer's would overwhelm both families and physicians.

The first step in diagnosis usually happens when friends or family members notice that something is different about the person. They notice that his personality and behavior have changed, or that he forgets where he is or who family members are, or that his forgetfulness is interfering with his ability to take care of himself. The person himself may not even be aware that there is a problem until others bring it up. These changes lead the person to make the decision to visit his doctor.

Because early diagnosis of dementia symptoms is so important to starting the right treatment, the doctor will first conduct a complete health examination. He will do a detailed interview with both the patient and those close to him, in order to get a thorough and accurate picture of the kinds of symptoms the person has been having. He will ask about the patient's medical history, including any long-term health issues the patient may have, any injuries or surgeries he has had (especially those involving the head), and the medications he is currently taking. If the person is taking a lot of medications, he may have the patient stop taking some of them, to make sure the dementia symptoms are not caused by the medications interacting with each other in harmful ways.

Along with the medical history, a thorough physical examination is done. The physical examination helps make sure that the symptoms are not caused by some treatable condition, such as thyroid disease, kidney failure, or nutritional deficiencies. The doctor may order tests of blood and urine to help find any of these problems. The doctor will look for weakness on one side of the body or other signs that the person may have had a stroke.

After the interview and the physical exam, if the doctor suspects that the person is developing some type of dementia, he may send the patient to see a specialist, a doctor who focuses on one aspect of health care.

A neurologist specializes in disorders of the nervous system. He may also suggest that the patient visit a psychiatrist or psychologist, just to make sure that the symptoms are not caused by a psychological problem such as anxiety or depression, which is fairly common in older people. A fourth specialist that may be involved is a neuropsychologist, who studies the relationship between brain functions and behavior, and can determine the level of impairment caused by brain disorders, stroke, or head injuries.

One test that is commonly used early in the diagnostic process to measure cognitive ability in older adults is the Mini-Mental State Examination, or MMSE. This eleven-question test takes only about ten minutes to do and examines skills such as memory, attention span, language skills, and orientation (knowing the day, time, and place), as well as the person's ability to copy a shape on paper, write a sentence, and follow written and verbal directions. For example, to test orientation, the examiner may ask the person what day it is, what year it is, or what state and country he lives in. To test memory, he may ask the person to repeat three words, such as apple, hat, and book, and then ask him to say them again later in the testing process. The highest score is thirty points. A score of twenty-four to thirty is considered normal, twenty to twenty-three indicates mild cognitive difficulty, ten to nineteen indicates moderate dementia, and below ten indicates severe dementia. The test can also be used several times with the same patient to measure changes over time.

The MMSE does have some limitations. Because the test relies so much on a person's ability to see, hear, and write, the results of the test can be affected if the person, for some reason, is unable to hear the directions well, see the paper, or understand English. He may not be able to draw or write well because of difficulty holding or using a pencil. The examiner takes these things into account when scoring the test. Also, highly educated people tend to score higher, even if they have Alzheimer's disease. The MMSE is never used to diagnose dementia all by itself; it must be used along with other diagnostic tests.

There is so much more involved, I will be adding to this as often as I can.