Dementia Diagnostic Approach

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It is neither practical nor essential to perform all the screening tests in every patient with dementia. The presenting features should guide investigations.

DEMENTIA Suspected cause

Alzheimer's disease -

Pick's disease

Appropriate investigations without neurological signs or systemic illness with neurological signs

(gait disturbance and incontinence)

with neurological signs and systemic symptoms and signs with 'stroke risk factors' (page 236)

with poor nutrition with metabolic and endocrine symptoms and signs with history of head trauma

- Tumour

Degenerative disease, -

e.g. Huntington's chorea

Normal pressure hydrocephalus -Frontal lobe tumour

Inflammatory disease, — e.g. Demyelinating disease (page 499) Vasculitis & collagen vascular disease

Infective disease, -

Syphilis

Meningitis

Multi-infarct state-

Nutritional disease

Metabolic and endocrine disease

Post-traumatic dementia

CT/MR scan

Confirmation: pathology

(post mortem)

CT/MR scan

Confirmation: pathology (biopsy)

CT/MR scan Genetics Confirmation: pathology (biopsy or post mortem)

CT/MR scan

Confirmation: CSF pressure monitoring (tumour-biopsy)

Serum autoantibodies Evoked responses CSF (immunology) CT/MR scan

Serum antibodies (viral) VDRL, TPHA HIV status CSF examination CT/MR scan

CT/MR scan

Serum Bt (thiamine) Red cell transketolase (thiamine)

Serum Bn2 Serum folate

Function tests:

- thyroid

- parathyroid

- renal

- hepatic

- adrenal

CT/MR scan

Neuropsychometric testing is performed:

- to diagnose early dementia

- to separate true dementia from pseudodementia

- to monitor progress or trials of treatment.

When the reason for dementia is unclear, comprehensive investigation is essential to ensure that treatable nutritional, infective, metabolic and structural causes are not overlooked.

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