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As the population ages, the incidence of Alzheimer's disease becomes greater. one in every 10 persons above age 65 and half of age 85 and above suffer from AD. The emotional toll of AD on family and caregivers is immeasurable. Alzheimer's Disease (AD), the most common of the dementia disorders, is a progressive brain disorder that occurs gradually and results in irreversible memory loss, unusual behavioral changes, personality changes, and a decline in thinking abilities (National Institute on Aging, 1997). Primarily a disease of older persons, AD affects an estimated four million people in the United States (Alzheimer's Association, 1997). But the exact number is unknown due to difficulty in diagnosis, especially in the early stages.

No single test diagnoses Alzheimer's disease. Diagnosing someone in the early stages of the disease is often challenging. "Memory loss isn't always the first symptom. It could be behavioral or language changes, or difficulty with everyday activities," says Norman Foster of Michigan University.

Doctors can diagnose the disease fairly accurately using a combination of assessments which may include:

• Personal medical history
• Physical exam and laboratory tests
• Mental status evaluation

These assessments are used to identify or eliminate other diseases or types of dementia such as brain tumors, head injuries, metabolic changes, depression, alcoholism, thyroid problems and vitamin deficiencies.

Personal history

The doctor may interview you and your loved one separately. The purpose of the interview is to identify signs and symptoms and to create a chronology of events.

"People with Alzheimer's disease often lose the ability to describe how or what they feel," says Glenn Smith, Ph.D., a neuropsychologist at Mayo Clinic, Rochester, Minn. "So we must rely on those who live with and care for them to explain how they have changed and to corroborate what they have told us."

Questions the doctor may ask include:

• What is your daily routine like?
• When did you first notice symptoms?
• Have the symptoms remained constant or grown worse over time?
• Are the symptoms interfering with daily activities?
• The doctor may also ask about your loved one's:

Personal medical history

• Family medical history, including mental illness and dementia
• Social and cultural background
• Prescription and over-the-counter medications, including vitamins, minerals and herbal preparations

Physical examination and laboratory tests

A basic physical examination is a crucial step in evaluating your loved one's current health status. The exam may include:

• A physical exam to look for medical illnesses — such as congestive heart failure or diabetes — that may contribute to cognitive impairment
• A neurologic exam to identify signs of Parkinson's disease, stroke, tumor or other medical conditions that may affect memory and thinking
• A head and brain scan — computerized tomography (CT) or magnetic resonance imaging (MRI) — to look for shrinkage (atrophy) of memory structures, stroke or fluid in the brain (hydrocephalus)
• Blood and urine tests to pinpoint any possible thyroid problems, anemia, medication imbalances or infections
• An electrocardiogram, which records the electrical activity of the heart
• A chest X-ray

Mental status evaluation

A doctor assesses your loved one's mental status. The assessment may include interviews and written tests to evaluate your loved one's:

• Sense of day and place
• Ability to understand, talk and remember
• Ability to perform daily activities, such as paying bills and remembering appointments
• Additional tests may include having your loved one do simple calculations, spell a word backward, and draw or copy a simple design.

Examples of memory test:
Doctor will quote three words to the patient, and ask the patient to remember these words. After the conversation has continued for sometime, the patient will be asked to say those three words back to the examiner. It is common for patients with early stage Alzheimer's to be unable to recollect. This test determines short term memory loss, one of the hallmarks of the disease.

The Doctor will hold an object, like a rod or button, in front of the person, and ask what it is. This is to determine their cognitive ability and word finding skills. Problems with word finding is another common effect of Alzheimer's Disease.

These tests tell your doctor which mental functions are affected and how severely. They also identify patterns that can provide clues about the nature of the underlying condition. If your doctor notes subtle or equivocal changes, he or she may refer you for a more extensive neuropsychological evaluation.

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