Last reviewed:September 2019
Last updated:May  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk 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 examination

Other diagnostic factors

  • mood changes
  • poor abstract thinking
  • constructional dyspraxia
  • prosopagnosia
  • autoprosopagnosia

Risk factors

  • advanced age
  • family history
  • genetics
  • Down's syndrome
  • low IQ
  • traumatic brain injury
  • depression
  • female sex
  • elevated plasma homocysteine level
  • cerebrovascular disease
  • hyperlipidaemia
  • lifestyle (smoking, obesity, diet high in saturated fats, and alcohol consumption)
  • less than secondary school education
  • artificially sweetened soft drink consumption

Diagnostic investigations

1st investigations to order

  • bedside cognitive testing
  • FBC
  • metabolic panel
  • serum thyroid-stimulating hormone (TSH)
  • serum vitamin B12
  • urine drug screen
  • CT
  • MRI
Full details

Investigations 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
Full details

Treatment algorithm

Contributors

Assistant Professor of Psychiatry

Mount Sinai School of Medicine

New York

NY

Disclosures

JN declares that she has no competing interests.

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.

Peer reviewersVIEW ALL

Medical Director

Kings Harbor Multicare Center

New York

NY

Disclosures

RJG declares that he has no competing interests.

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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