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Diary of a Family Physician

Evaluation of Suspected Dementia

E. Seth Kramer, DO, MPH
Melissa N. Johnson, MD
Bradford Winslow, MD

American Family Physician. 2025;112(6):657-667.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Dementia is a major neurocognitive disorder involving deficits that interfere with daily function. Age is the greatest risk factor for developing the disease. Other risk factors include family history, cardiovascular disease, uncontrolled diabetes, and lower education levels. The initial evaluation for dementia involves recognizing subtle signs that are often missed or mistaken for normal aging. Screening tools include the Mini-Cog, Memory Impairment Screen (MIS), and questionnaires that are completed by caregivers or friends. If cognitive impairment is suspected, a more detailed evaluation should be performed using tools such as the Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status (SLUMS), or Rowland Universal Dementia Assessment Scale (RUDAS). A thorough history should be taken and a medication review and physical examination should be performed for the assessment of vision; hearing; cardiovascular, nutritional, and functional status; neurologic function; and psychiatric status. Laboratory testing, such as vitamin B12 and folate levels, thyroid function, complete blood cell count, and comprehensive metabolic panel, may be necessary to rule out underlying conditions. Brain imaging with noncontrast magnetic resonance imaging (or non-contrast computed tomography of the head if magnetic resonance imaging is unavailable or contraindicated) can rule out secondary causes. Differentiating dementia from potentially reversible conditions such as depression and delirium is essential. Referral to a neurologist is recommended for early-onset symptoms (before 60 years of age), for severe behavioral disturbances, or if the diagnosis is unclear.

E. SETH KRAMER, DO, MPH, is an assistant professor and family medicine faculty member at the University of Colorado Anschutz School of Medicine, Aurora.

MELISSA N. JOHNSON, MD, is an assistant professor and family medicine faculty member at the University of Colorado Anschutz School of Medicine.

BRADFORD WINSLOW, MD, FAAFP, is an associate professor and family medicine faculty member at the University of Colorado Anschutz School of Medicine.

Address correspondence to E. Seth Kramer, DO, MPH, at erik.kramer@cuanschutz.edu.

Author disclosure: No relevant financial relationships.

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