Understanding Dementia Tests and Assessments

Your guide to understanding dementia tests and assessments

When memory problems or cognitive changes raise concerns, healthcare professionals use various tests to diagnose dementia. Understanding these assessment tools can help prepare both you and your loved one for what to expect during the diagnostic process on the NHS.

Why Dementia Testing Is Important

Early-stage diagnosis of dementia can provide numerous benefits, including:

Access to treatments that may help manage symptoms

Time to plan for future care needs

Opportunity to participate in clinical trials

Better understanding of behavioural changes

Ability to address safety concerns proactively

Reduced risk of developing complications

For more information about the benefits of identifying dementia early, visit our guide on early diagnosis of dementia.

The Dementia Assessment Process

Tests for diagnosing dementia typically involve several steps and multiple healthcare professionals:

Initial Consultation with GP

The first step usually involves visiting a GP, who will:

Take a detailed medical history

Ask about problems with your memory or thinking

Perform a basic physical examination

Conduct initial mental ability tests

Order a blood test to rule out other conditions

Specialist Referral

If the GP suspects dementia, they will likely refer you to a dementia specialist such as:

Neurologist (brain and nervous system specialist)

Geriatrician (elderly care specialist)

Psychiatrist (mental health specialist)

Memory clinic (specialised team approach)

Comprehensive Assessment

The specialist will conduct several different tests to diagnose dementia, which may include:

Detailed cognitive assessments to evaluate cognition

Brain scans to check for signs of stroke or changes in the brain

Further blood tests

Functional assessments of daily living skills

Interviews with family members about observed changes

Common Cognitive Tests for Dementia

Healthcare professionals use various screening tools and tests to assess cognitive function:

Mini-Mental State Examination (MMSE)

This 30-point test evaluates:

Orientation to time and place

Short-term memory through a recall test

Attention and calculation

Language abilities

Visual-spatial skills

The MMSE takes about 10 minutes to complete and includes tasks such as naming objects, following commands, and copying a drawing.

Montreal Cognitive Assessment (MoCA)

The MoCA is a more sensitive test that includes:

Executive function and abstraction tasks

Animal naming (verbal fluency)

Clock-drawing test

Three-dimensional cube copy

Trail-making test

This 30-point assessment takes about 15 minutes and is particularly useful for detecting mild cognitive impairment that may overlap with dementia.

What Is the 5-Word Test in Dementia Assessment?

The 5-Word Test (5WT) is a memory screening tool that evaluates both immediate and delayed recall. Here’s how it works:

The person is shown five words (often common items like “apple,” “carpet,” “fork,” “bus,” and “daisy”)

They’re asked to read the words aloud and remember them

A category cue is given for each word (e.g., “fruit” for “apple”)

After a distraction task lasting about 3-5 minutes, they’re asked to recall the five words

If they can’t remember a word, the category cue is provided as a hint

The scoring works as follows:

1 point for each word correctly recalled without cues (maximum 5 points for immediate recall)

1 point for each word correctly recalled without cues after the delay (maximum 5 points for delayed recall)

The total score ranges from 0 to 10 points

This test is particularly useful because it distinguishes between memory encoding problems (common in dementia) and retrieval difficulties (which can occur with normal ageing). A score below 8 out of the possible 10 points may warrant further investigation, while scores of 5 or below often indicate significant memory impairment.

What Is the 2-Finger Test in Dementia?

The 2-finger test, while not as formally structured as other assessments, evaluates visual-spatial awareness and body schema understanding. During this assessment:

The examiner raises two fingers (usually the index and middle fingers)

The person being tested is asked to copy this gesture with their own hand

The test may be repeated with different finger combinations

This simple test helps assess:

Visual perception

Motor planning

Ability to imitate actions

Understanding of body positioning

Difficulty with this test may indicate issues with parietal lobe function, which can be affected in certain types of dementia, particularly Alzheimer’s disease.

Clock Drawing Test

This seemingly simple test provides rich information about cognitive function:

The person is asked to draw a clock face showing a specific time (often 11:10)

The task assesses multiple cognitive domains, including:

Visual-spatial ability

Executive function

Abstract thinking

Planning

Following instructions

Errors in clock drawing, such as number sequencing problems or misplaced hands, can indicate different types of cognitive impairment.

Brain Imaging Tests and Scans

Brain scans play a crucial role in dementia diagnosis by providing visual evidence of changes in the brain:

CT Scan (Computed Tomography)

This X-ray-based scan can identify:

Signs of stroke that might cause vascular dementia

Brain tumours that could cause cognitive symptoms

Bleeding in the brain

Significant brain atrophy

CT scans are often the first type of brain scan used on the NHS when investigating memory problems.

MRI (Magnetic Resonance Imaging)

More detailed than CT scans, MRIs can detect:

Subtle changes in brain structure

Small vascular lesions

Patterns of brain atrophy associated with specific types of dementia

Changes in white matter

An MRI or CT scan is essential to diagnose specific types of dementia and to check for signs of stroke or a brain tumour.

PET Scan (Positron Emission Tomography)

This functional imaging technique can:

Measure brain activity patterns

Detect amyloid plaques (a hallmark of Alzheimer’s disease)

Help distinguish between different types of dementia

Laboratory Tests

Blood and other laboratory tests help rule out other conditions that could cause dementia symptoms:

Complete blood count

Thyroid function tests

Vitamin B12 levels

Liver and kidney function tests

Glucose levels

Tests for infections

The Alzheimer’s Society notes that blood tests are a routine part of the diagnostic process to identify conditions that may cause memory problems.

In some cases, examination of cerebrospinal fluid (obtained through a lumbar puncture) may be performed to look for biomarkers of specific dementia types.

Functional Assessments

Understanding how cognitive changes affect daily life is crucial for diagnosis and care planning:

Activities of Daily Living (ADLs)

These assessments evaluate basic self-care abilities:

Bathing and personal hygiene

Dressing

Toileting

Eating

Mobility and transferring

Healthcare professionals assess these to determine how dementia symptoms are affecting independence.

Instrumental Activities of Daily Living (IADLs)

These evaluate more complex daily tasks:

Managing finances

Taking medications correctly

Shopping and meal preparation

Using transportation

Using the telephone or other communication devices

Housekeeping tasks

Difficulties with IADLs often appear earlier in the dementia process and may be the first functional changes families notice.

Diagnosing Different Types of Dementia

Tests and scans help specialists determine the type of dementia present:

Alzheimer’s Disease

Diagnosis typically involves:

Memory tests showing characteristic patterns of memory loss

Brain scans showing hippocampal and cortical atrophy

Vascular Dementia

Identified through:

Brain scans showing evidence of strokes or blood vessel disease

Step-wise pattern of cognitive decline

Frontotemporal Dementia

Distinguished by:

Early personality and behavioural changes

MRI showing shrinkage in the frontal and temporal lobes

Dementia with Lewy Bodies

Characterised by:

Visual hallucinations

Fluctuating levels of alertness

Parkinson’s-like movement symptoms

After the Diagnosis: Next Steps

If dementia is diagnosed, the healthcare team will discuss:

The specific type of dementia (if identifiable)

Treatment options

Prognosis and expected progression

Care planning recommendations

Support resources for the person and their family

For comprehensive information about caring for someone with dementia, please refer to our dementia care guides.

Supporting Your Loved One Through Testing

The assessment process can be stressful. Here are some ways to provide support:

Before the Assessment

Schedule appointments for the person’s best time of day

Ensure they’ve had adequate rest and nourishment

Bring a list of current medications and medical history

Prepare them for what to expect

During the Assessment

Provide reassurance and emotional support

Help explain instructions if needed

Take notes about the doctor’s findings

After the Assessment

Review and discuss the results together

Address any concerns or fears

Begin making plans based on recommendations

Getting Support for Assessment and Care

If you’re concerned about memory problems or cognitive decline, or need assistance following a dementia diagnosis, contact us to discuss how our specialised services can help.

Our team can provide:

Advice on preparing for assessments

Support during the diagnostic process

Specialised dementia care services

Guidance on creating safe environments

Respite for family caregivers

Remember that early assessment leads to early diagnosis, which provides the best opportunity for effective treatment and care planning.