Clinicians diagnose "probable" Alzheimer's disease by doing a thorough diagnostic workup. This can include a complete medical history; physical examination to find evidence of any underlying medical or neurological disorders that may be contributing to symptoms; neuropsychological tests that gauge memory, attention, language skills, and problem-solving abilities; laboratory tests that can include blood and urine samples; and brain imaging scans, such as a CT scan, MRI, SPECT, or PET scan, which can identify changes in brain structure or activity.
For Medicare beneficiaries, a new annual wellness visit (AWV) includes “detection of any cognitive impairment” as well as personalized prevention plan services. A health provider will assess cognitive impairment by direct observation and consideration of information obtained from patient reports and concerns raised by family members, friends, caregivers, or others. This provision, part of the new healthcare reform law, took effect January 1, 2011.
A beneficiary is entitled to an AWV by a primary care provider or other health provider after having Medicare Part B coverage for at least 12 months and not having had an AWV or the “Welcome to Medicare Visit” initial preventative physical exam within the past 12 months. There is no coinsurance or deductibles for the AWV.
The causes of dementia are complex; a complete clinical evaluation by a skilled clinician will identify the primary cause of dementia in more than 90% of cases. Clinicians diagnose Alzheimer’s disease as the cause of dementia in about 60% of individuals living with the disease.
Alzheimer's disease is characterized by two types of abnormal lesions in the brain: Beta-amyloid plaques, sticky clumps of protein fragments and cellular material that form outside and around neurons, and neurofibrillary tangles, insoluble twisted fibers composed largely of the protein tau that build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are still unclear whether they cause it or are a by-product of it.