Triggers that signal the need for assessment for early-stage dementia.
The components of an initial assessment, including history and physical examination, mental status tests and tests of functional performance.
A flowchart for early recognition and assessment, including assessment for delirium and depression.
Guidelines for interpretation of test results and appropriate interventions.
An algorithm for reassessment and referral.
The role of neuropsychologic testing in patients with mixed test results.
Collaborative continuity of care for the patient and caregivers.
Knowledge of the individual patient for accurate assessment of changes.
Indications for evaluation for dementia include memory loss or other cognitive problems. Evaluation is indicated in elderly patients whose competency is questioned, in anxious or depressed patients with cognitive complaints and in patients with no complaints but who are suspected of having cognitive impairment.
Cognitive and functional deficits should be substantiated by a reliable informant.
Cognitive or mental status testing should include assessment of attention, level of arousal, orientation, recent and remote memory, language, visuospatial function, calculations and judgment.
Neurologic history and examination, with special attention to gait disorders, focal abnormalities and extrapyramidal signs.
Diagnostic tests to exclude metabolic or structural causes of dementia depend on the suspected diagnosis. Tests may include complete blood cell count, serum electrolyte levels, glucose level, blood urea nitrogen and creatinine levels, liver and thyroid function tests, serum vitamin B12 and folate levels, and syphilis serology.
Neuroimaging should be considered based on the clinical manifestations.
Complaints of memory loss and other cognitive impairment without functional impairment.
Report of functional change with normal performance on cognitive screening tasks.
The diagnosis of Alzheimer's disease is established but additional information is needed to aid in decision making, treatment and counseling.
Lack of physician experience with cognitive screening tests.
Insight into techniques for behavioral and environmental intervention, and information for caregivers are needed.
Psychiatric management, including ongoing assessment, monitoring of symptoms at four- to six-month intervals, prompt intervention, and patient and family counseling about driving, supportive services, and legal and financial planning.
Behavioral management, including pet and art therapy, environmental interventions, behavior modification and reality orientation.
Treatment with psychoactive agents and other medications.
Treatment of cognitive symptoms with cholinesterase inhibitors, vitamin E and seligilene.
Treatment of depression and sleep disorders.