The first step in diagnosing Alzheimer’s is talking to your doctor about your medical history. As a patient, you have the right to receive a cognitive test during your Medicare Annual Wellness visit. If your doctor does not suggest one, you can request it. If you show signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your cognitive function and develop a care plan. (6)

Your doctor will ask about your symptoms, how long you've had them, and how they affect your daily life. It's a good idea to have a family member or friend with you to provide more information. Then, a doctor will conduct a physical exam to check your reflexes, muscle strength, vision, hearing, coordination, and balance. Next, the doctor will perform mental status tests to assess your memory and other thinking skills. These tests can be brief or more detailed, depending on the information needed. They help compare your mental function to others of a similar age and education level and may be done over multiple visits by a specialist, such as a neurologist or neuropsychiatrist, or at a memory clinic instead of your regular doctor.

Lab tests, including blood work, help rule out other conditions that might cause similar symptoms, such as thyroid disorders or low vitamin B-12 levels. Advanced blood tests can now measure levels of beta-amyloid and tau proteins, which are associated with Alzheimer's disease. However, these newer tests are not yet widely available, may not be covered by insurance, and may not perform well for all racial and ethnic groups. (3)

Current blood tests for Alzheimer’s may work better for white individuals than for Black, Hispanic, and Asian individuals. Studies show that some groups, especially Hispanic people with memory problems, have lower levels of amyloid, which these tests look for. More research is needed to make sure the tests work well for everyone. (5)

People of color should ask for care that respects their culture. When advocating for better Alzheimer’s tests for Black or Hispanic individuals, doctors should consider cultural differences, language issues, and racial biases, while making sure people have access to the right resources and doctors.

• There is no single best test for checking memory and thinking skills, and no test is accepted by everyone.
• The Mini-COG and MoCA tests are commonly used, but all cognitive tests have limitations—especially for people from different cultural backgrounds or who speak different languages.
• Some test questions may not be useful if they rely on unfamiliar concepts, such as naming an animal someone has never seen.
• Doctors do not rely only on test scores; they also consider other signs, symptoms, and clinical observations.
• These tests do not provide a diagnosis and only reflect how someone is functioning at a single point in time.
• Memory and thinking abilities can change over time, so the tests are mainly used to track changes rather than confirm a disease.

In some cases, Cerebrospinal Fluid (CSF) tests may be recommended to measure the levels of amyloid and tau in the spinal fluid. Amyloid and tau are two key proteins in the brain involved in Alzheimer’s disease. This test can help confirm a diagnosis of Alzheimer's disease, especially if symptoms are rapidly worsening. (2)

Brain imaging plays an important role in diagnosing Alzheimer's. Here are some common tests: (1,4)

• Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to show brain shrinkage.
• Computerized Tomography (CT) Scan: Uses X-rays to rule out other conditions.
• Positron Emission Tomography (PET) Scans: Shows areas where brain energy use is reduced.
• Amyloid PET Scans: Detects amyloid plaques linked to Alzheimer’s disease.

While many of these tests are safe and minimally invasive, Alzheimer’s diagnosis is not based on one single test.

It involves a comprehensive assessment of symptoms, medical history, lab results, and brain imaging. Getting a diagnosis helps ensure the right care, planning, and support.