How Doctors Test for Dementia -- and Why

May 28, 2021

More than 6 million Americans have been diagnosed with Alzheimer’s Disease – the most common form of dementia.  It afflicts one in nine Americans over the age of 65, and as our population lives longer, it’s expected to be a much bigger problem.  There is no cure, so is it worth getting tested?  And what does that involve? 

Dr. Carol Manning heads the Virginia Alzheimer's Disease Center at UVA and will speak at a free online forum June 1 at noon.
Credit University of Virginia

Donald Trump will be remembered for many things, including his public description of a test used to measure cognitive function – our ability to think, to remember, speak and solve problems.

“Like you’ll go ‘Person, Woman, Man, Camera, TV,’: he told Fosx News. 10 minutes, 20 minutes later they’ll say, ‘Give us that again,’ and you go, ‘Person, Woman, Man, Camera, TV.’  They say, ‘That’s amazing!  How did you do that?’”

Patients are also put through a series of mental exercises, asked to identify or draw pictures, to solve problems and list words from a given category.

Trump seemed to think the test measured intelligence.  In fact, it’s used to help doctors pinpoint changes in our brains.  Dr. Carol Manning, director of the Virginia Alzheimer’s Disease Center at UVA, says they may also order a scan using magnetic resonance imaging.

“The first thing we do is a regular MRI, which just looks at the structure of the brain to see, ‘Is there a lot of atrophy or brain shrinkage?  Is there a lesion in the brain that would be the reason that the person is having cognitive decline.”

And they can look for fragments of protein in the brain called amyloid.

“There are certain PET scans  where we can look at the amount of amyloid in the brain, and that is a marker of Alzheimer’s Disease,” Manning says.

Sometimes the  findings suggest typical, age-related changes.

“Normal age related decline includes things like forgetting names -- very, very common. Proper nouns – common to have a harder time with that.” Manning explains.

But they could also point to reasons why a person might struggle with activities of daily living – managing finances that used to seem easy, remembering recent events or doing things they’ve done many times before.

“If someone, for example, who’s been cooking for many years and been cooking the same recipes suddenly can’t remember how to do them or can’t get dinner on the table at the right time.”

When that happens, Manning says, it’s worth being tested, even though there’s no cure for dementia.

“There are things that can be done, and even if it’s something like Alzheimer’s Disease, where we cannot cure it at this point, there are medicines that can slow the rate of decline.  We can work with patients and their families to help them understand what is coming down the road and how to prepare for it.”

And there are many studies planned or underway – three of them at UVA and three others at Virginia Commonwealth University.  One hopes to find out whether a medication that proved useful in laboratory animals could help prevent the development of dementia in people with risk factors.  Another will help families care for loved ones already diagnosed, and in a few weeks UVA will test a genetically engineered medication that could slow the progression of mental decline.

“We do have a trial coming up that is looking at a monoclonal antibody which is a disease modifying treatment.  That is for people in mild stages of dementia.”

If you or someone you know is concerned, would like to be tested or to take part in a study, Carol Manning says the first stop is a primary care doctor who may then refer patients to a major medical center for a full evaluation.  I’m Sandy Hausman.

For more information on the study of early Alzheimer’s Disease soon to begin at UVA go to https://clinicaltrials.gov/ct2/show/NCT04619420

And to learn more about dementia,  join Dr. Carol Manning’s free online talk  June 1 at noon https://alumni.virginia.edu/events/event/ZKfHO0LX3J