Clinical assessment in dementia

Abstract

With the availability of treatments for Alzheimer's disease, and a widening sphere of management approaches for all dementias, accurate, early diagnosis has become increasingly important. This contribution highlights the features of assessment that enable clinicians to distinguish patients with dementia from those without, as well as helping to differentiate between the different causes of the syndrome. It describes a structured process for assessing dementia – from taking a history to investigations – that will aid clinicians in making an accurate diagnosis The diagnosis of dementia requires several steps, but the cornerstone is the history. A comprehensive history, detailing the onset, course and manifestations of symptoms, is essential to exclude the two main conditions that can mimic dementia: delirium and depression. The history must not solely concentrate on the presenting complaint; all facets of cognitive function should be enquired about. A detailed medical, psychiatric and drug history may also give an indication of the underlying cause of the symptoms. Mental state examination may reveal more evidence of cognitive impairment – e.g. disinihibition, reduced attention and poor personal care. It is also important to assess for non-cognitive features of dementia, such as depression, agitation and hallucinations. A standard cognitive screening test aids the assessment and may indicate areas of impairment that were not highlighted in the history or mental state examination. Physical examination and investigations, such as EEG and CT scanning, can confirm the presence of a dementia and may also indicate the subtype.