Summary
Definition
History and exam
Key diagnostic factors
- memory loss
- disorientation
- nominal dysphasia
- misplacing items/getting lost
- apathy
- decline in activities of daily living and instrumental activities of daily living (IADLs)
- personality change
- unremarkable initial physical exam
Other diagnostic factors
- mood changes
- poor abstract thinking
- constructional dyspraxia
- prosopagnosia
- autoprosopagnosia
Risk factors
- advanced age
- family history
- genetics
- Down syndrome
- cerebrovascular disease
- lifestyle factors and medications
- less than high school education
- traumatic brain injury
- depression
- hearing loss
- hyperlipidemia
- female sex
- elevated plasma homocysteine level
- artificially sweetened soft drink consumption
Diagnostic tests
1st tests to order
- bedside cognitive testing
- CBC
- metabolic panel
- serum thyroid-stimulating hormone (TSH)
- serum vitamin B12
- urine drug screen
- CT
- MRI
Tests to consider
- cerebrospinal fluid (CSF) analysis
- serum rapid plasma reagin/Venereal Disease Research Laboratory (VDRL)
- serum HIV
- formal neuropsychological testing
- genetic testing
- fluorodeoxyglucose-PET (FDG-PET)
- single-photon emission CT (SPECT)
- electroencephalogram (EEG)
Emerging tests
- amyloid-PET
Treatment algorithm
all patients
Contributors
Authors
Judith Neugroschl, MD
Associate Professor of Psychiatry
Alzheimer's Disease Research Center
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
JN participates in research funded by National Institutes for Health (NIH) grants. The Alzheimer's Disease Research Center is a site for clinical research but JN is not the site Principal Investigator, has no role in purchasing nor choosing the studies, and gains no compensation if they succeed. JN helps to edit the Focus on Healthy Aging Alzheimer's yearly report.
Acknowledgements
Dr Judith Neugroschl would like to gratefully acknowledge Dr Brandy R. Matthews, Dr Asif S. Bhutto, and Dr Julie K. Gammack, the previous contributors to this topic.
Disclosures
BRM, ASB, and JKG declare that they have no competing interests.
Peer reviewers
Roy J. Goldberg, MD, FACP, AGSF, CMD
Medical Director
Kings Harbor Multicare Center
New York
NY
Disclosures
RJG declares that he has no competing interests.
Philip Scheltens, MD, PhD
Professor of Neurology
Department of Neurology/Alzheimer Center
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
PS declares that he has no competing interests.
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