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Many different conditions can cause dementia symptoms. Your health care provider has the difficult task of finding the cause of your symptoms. This is very important, because some causes of dementia are reversible with treatment while others are not.

The process of narrowing down the possibilities to reach your diagnosis is complicated. Your health care provider will gather information from several different sources. At any time in the process, he or she may consult an expert in dementia (geriatrician, neurologist, psychiatrist).

The first step in the evaluation is the medical interview. You will be asked questions about your symptoms and when they appeared, about medical problems now and in the past, about medications you have taken now and in the past, about family medical problems, and about your habits and lifestyle. A physical examination will look for physical disabilities and signs of underlying conditions, such as high blood pressure, heart and blood vessel disease, and previous strokes. It will also include a mental status examination. This involves following simple directions and answering questions that check orientation, attention, language, and memory. Neuropsychological testing may be done to identify the extent of dementia.

Neuropsychological testing

Neuropsychological testing is a detailed cognitive assessment that helps to pinpoint and document a person's cognitive problems and strengths. Results vary with the site and severity of vascular disease in the brain.

• This testing can help find subtle or early cognitive deficits and give a more accurate diagnosis of the problems, thus assisting in treatment planning.
  
  
• The testing involves answering questions and performing tasks that have been carefully prepared for this purpose. It is carried out by a psychologist or other specially trained professional.
  
  
• It assesses the individual's appearance, mood, anxiety level, and experience of delusions or hallucinations.
  
  
• It assesses cognitive abilities such as memory for words and visual patterns, attention, orientation to time and place, use of language, and ability to carry out various tasks and follow instructions.
  
  
• Reasoning, abstract thinking, and problem solving are also tested.

Lab tests

These include blood tests to rule out infections, blood disorders, chemical abnormalities, hormonal disorders, and liver or kidney problems that could cause or mimic dementia symptoms. Lab tests can also pinpoint conditions such as diabetes and certain vascular disorders that could underlie dementia.

Imaging studies

Brain scans are very helpful in detecting stroke. They can also rule out certain other conditions that cause dementia.

• MRI or CT scan of the brain usually shows signs that indicate stroke or vascular disease, including bleeding.
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• Positron-emission tomography (PET) or single-photon emission computed tomography (SPECT) scan may be helpful in distinguishing vascular dementia from Alzheimer's Disease. These scans are available only at some large medical centers.

Other tests

Other tests may be done to look for conditions that commonly cause stroke and vascular disease.

• Echocardiography - Detects certain types of heart disease
  
  
• Holter monitoring - Detects heart rhythm disorders
  
  
• Carotid duplex Doppler ultrasound - Detects blockage of the carotid arteries, the main arteries leading to the brain

Tests may also be done to rule out other causes of dementia.

• Electroencephalogram (EEG) - Detects abnormal electrical activity in the brain
  
  
• Cerebral angiography - Not used routinely in the evaluation of vascular dementia but sometimes used to detect vascular conditions, including stroke