Pillar Two

Diagnosis — Understanding
Your Cognitive Health

Recognizing the early signs of dementia and pursuing a timely diagnosis can open the door to treatment, planning, and support. Here's what you need to know.

A physician reviewing cognitive assessment results with a patient during a consultation

Early diagnosis opens the door to treatment, planning, and support — before significant damage has occurred.

Early Warning Signs

10 Warning Signs of Dementia

These signs go beyond normal age-related forgetfulness. If you or a loved one experience several of these, it's time to consult a doctor. Early detection significantly improves outcomes.

1Memory loss that disrupts daily life

Forgetting recently learned information, important dates, or events — and increasingly relying on memory aids or family members to recall things you used to handle independently.

2Challenges in planning or problem solving

Difficulty following a familiar recipe, keeping track of monthly bills, or concentrating on tasks that involve numbers. Making more errors than usual in things you've done for years.

3Difficulty completing familiar tasks

Trouble driving to a familiar location, managing finances, or remembering the rules of a favorite game. Needing repeated guidance for tasks that were once routine.

4Confusion with time or place

Losing track of dates, seasons, and the passage of time. Sometimes forgetting where you are or how you got there. Difficulty understanding something if it isn't happening immediately.

5Trouble understanding visual images

Problems with balance, difficulty reading, trouble judging distance, and problems distinguishing contrast. These can also be signs of cataracts — see a doctor to rule out other causes.

6New problems with words in speaking or writing

Stopping in the middle of a conversation and having no idea how to continue. Struggling to find the right word, calling things by the wrong name ("that thing for the hand" instead of "watch").

7Misplacing things and losing the ability to retrace steps

Putting things in unusual places (iron in the refrigerator, wallet in the freezer). Unable to go back over steps to find a lost item. May accuse others of stealing.

8Decreased or poor judgment

Changes in judgment or decision-making. Paying less attention to personal grooming. Falling for scams or giving large amounts of money to telemarketers.

9Withdrawal from work or social activities

Removing oneself from hobbies, social activities, or other engagements. Trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.

10Changes in mood and personality

Becoming confused, suspicious, depressed, fearful, or anxious. Easily upset when outside their comfort zone. Mood swings that seem out of character for the individual.

Types of Dementia

Not All Dementia Is Alzheimer's

Alzheimer's disease accounts for the majority of dementia cases, but there are several distinct types — each with different underlying causes, progression patterns, and treatment approaches.

60–80%

Alzheimer's Disease

The most common form. Characterized by amyloid plaques and tau tangles in the brain. Symptoms typically begin with short-term memory loss and progress to affect language, reasoning, and daily function. The only form currently with FDA-approved disease-modifying therapies.

~10%

Vascular Dementia

Caused by reduced blood flow to the brain, often following a stroke or series of mini-strokes. Symptoms may appear suddenly after a vascular event or progress more gradually. Risk factors overlap heavily with heart disease. Especially prevalent in Louisiana given the state's high rates of hypertension and diabetes.

~5%

Lewy Body Dementia

Caused by abnormal deposits of alpha-synuclein protein in the brain. Distinct features include vivid hallucinations, significant fluctuations in alertness, REM sleep behavior disorder, and Parkinson's-like movement symptoms. Often misdiagnosed as Alzheimer's or Parkinson's disease.

~5%

Frontotemporal Dementia (FTD)

Affects the frontal and temporal lobes, causing changes in personality, behavior, and language rather than memory loss. More commonly strikes people in their 50s and 60s. Often misdiagnosed as a psychiatric condition. Includes variants such as Pick's disease and Primary Progressive Aphasia.

* Many patients have mixed dementia — features of more than one type simultaneously. A comprehensive workup is essential for accurate diagnosis and appropriate treatment planning.

The Process

How Does Diagnosis Work?

Diagnosing dementia involves ruling out other causes and identifying the specific type. There is no single test — a comprehensive evaluation is required.

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1

Medical History & Interview

Your doctor will ask about your symptoms, when they began, and how they've changed over time. Input from a family member or close friend is often invaluable, as patients may not be aware of the full extent of changes.

2

Cognitive & Neuropsychological Testing

Standardized tests assess memory, problem-solving, attention, counting, and language. Common screening tools include the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Mini-Cog. More detailed neuropsychological testing may follow.

3

Physical & Neurological Exam

A neurological exam assesses reflexes, coordination, balance, sensory function, and eye movements to identify signs that may indicate other neurological conditions contributing to symptoms.

4

Laboratory Tests

Blood tests rule out reversible causes of cognitive decline such as thyroid disorders, vitamin B12 deficiency, infections, or medication interactions — all of which can mimic dementia symptoms.

5

Brain Imaging

CT or MRI scans can reveal strokes, tumors, or shrinkage of brain regions associated with specific dementias. PET scans can detect amyloid plaques or glucose metabolism patterns characteristic of Alzheimer's disease.

6

Biomarker Testing (Advanced)

Cerebrospinal fluid (CSF) analysis or specialized blood tests (e.g., plasma p-tau217) can detect Alzheimer's biomarkers with high accuracy. These tests are increasingly being used in clinical practice to confirm diagnosis before initiating anti-amyloid therapy.

Screening Tools

Common Cognitive Screening Exams

Screening tools are quick, office-based tests used to detect potential cognitive impairment. A positive screen should be followed by comprehensive neuropsychological evaluation — screening alone is not a diagnosis.

Mini-Cog

3 minutes

A brief, widely-used screen combining a 3-item word recall and a clock-drawing test. Designed for primary care settings. Sensitive for detecting dementia but limited in detecting mild cognitive impairment. Available in multiple languages.

MoCA

Montreal Cognitive Assessment — 10 minutes

More sensitive than the MMSE for detecting mild cognitive impairment. Assesses attention, concentration, executive functions, memory, language, visuoconstructional skills, and orientation. Score of 26+ out of 30 is considered normal.

MMSE

Mini-Mental State Examination — 10 minutes

One of the most widely used cognitive screening tools. Assesses orientation, registration, attention, recall, language, and visuospatial ability. Scores range from 0–30; below 24 suggests possible impairment. May miss early or mild cases.

Common Questions

Frequently Asked Questions

Do I need to see a specialist to get a dementia diagnosis?

Your primary care physician can perform initial screening and rule out other causes. However, a definitive diagnosis — especially for less common dementias or atypical presentations — typically requires evaluation by a neurologist, geriatrician, or neuropsychologist. If anti-amyloid therapy is being considered, specialist involvement is essential.

Is normal aging the same as dementia?

No. Normal age-related changes include occasionally forgetting a name but remembering it later, making the occasional error when managing finances, and needing a bit more time to learn new things. Dementia involves significant, progressive changes that interfere with daily life — not occasional lapses that correct themselves.

What is Mild Cognitive Impairment (MCI)?

MCI is an intermediate stage between normal cognitive aging and dementia. People with MCI have noticeable cognitive changes that go beyond normal aging but don't yet significantly interfere with daily life. About 10–15% of people with MCI progress to dementia each year, though some remain stable or even improve. MCI is now recognized as an important intervention window for emerging disease-modifying therapies.

Can a blood test diagnose Alzheimer's?

Yes — increasingly. Blood tests measuring plasma phospho-tau 217 (p-tau217) and amyloid beta ratios now show high accuracy (90%+) for detecting Alzheimer's-related brain changes. The FDA cleared the first blood-based Alzheimer's diagnostic (Lumipulse) in 2024. These tests are becoming more widely available through neurologists and memory clinics but are not yet standard in routine primary care.

How early can Alzheimer's be detected?

Alzheimer's brain changes begin 15–20 years before symptoms appear. With biomarker testing (PET scans or blood tests for amyloid/tau), it is now possible to detect these changes in the preclinical stage. Early detection opens the window for disease-modifying therapies like lecanemab and donanemab, which are most effective before significant neuronal damage has occurred.

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