Dementias History And Clinical Examination

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When obtaining a history from a demented person and relative, establish:

- Rate of intellectual decline - Nutrition status

- Impairment of social function - Drug history

- General health and relevant disorders, - Family history of dementia.

e.g. stroke, head injury

Tests to assess intellectual function are designed to check:

- Memory

- Abstract thought

- Judgement

- Specific higher cortical functions

On neurological examination note:

- Focal signs

A simple bedside battery of tests includes:

- Age

- Dates of World War II

- Place of birth

- Months backwards

- Date of birth

- Interpretation of proverbs

- School

- Following three stage commands

- Date

- Read and obey instructions

- Time of day

- Name objects

- Season of year

- Copy design

- Prime Minister

- Serial 7s

In early or pseudodementla a formal

assessment from a clinical psychologist is advisable.

- Involuntary movements

Pout reflex

Pout reflex

Tap lips with tendon hammer - a pout response is observed

- Pseudobulbar signs

- Primitive reflexes:

Glabellar reflex

Patient cannot inhibit blinking in response to stimulation (tapping between the eyes)

Grasp reflex

Grasp reflex

Stroking palm of hand induces 'grasp

Primitive reflexes are present in infancy and in aged people, as well as in dementia

Stroking palm of hand induces 'grasp

Primitive reflexes are present in infancy and in aged people, as well as in dementia

Glabellar reflex

Patient cannot inhibit blinking in response to stimulation (tapping between the eyes)

Palmomental reflex
Quick scratch on palm of hand induces sudden contraction of mentalis muscle in face

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