Summary
Definition
History and exam
Key diagnostic factors
- history of stroke(s)
- difficulty solving problems
- apathy
- disinhibition
- slowed processing of information
- poor attention
- retrieval memory deficit
- frontal release reflexes
- focal neurological signs
- impaired gait and balance
Risk factors
- age >60 years
- obesity
- hypertension
- cigarette smoking
- diabetes mellitus
- hypercholesterolaemia
- alcohol misuse
Diagnostic investigations
1st investigations to order
- FBC
- erythrocyte sedimentation rate
- blood glucose level
- renal and liver function tests
- vitamin B12
- folate
- thyroid function
- CT or MRI brain
- ECG
Investigations to consider
- syphilis serology
- lupus anticoagulant, antiphospholipid, and antinuclear testing
- neuropsychological testing
- carotid duplex ultrasound
- echocardiogram
Treatment algorithm
atherosclerotic ischaemic disease
cardioembolic disease
Contributors
Authors
Peter Passmore, BSc, MB, BCh, BAO, MD, FRCP (Lond, Glasg), FRCPI
Professor of Ageing and Geriatric Medicine
Queen's University Belfast
Belfast
UK
Disclosures
PP declares that he has no competing interests.
Acknowledgements
Dr Peter Passmore would like to gratefully acknowledge Dr David Wilson, Dr Grant Bateman, and Dr Velandai Srikanth, previous contributors to this topic. DW has received educational grants from Shire. GB and VS 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.
Craig N. Sawchuk, PhD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
Seattle
WA
Disclosures
CNS declares that he has no competing interests.
Bryan Bernard, PhD
Assistant Professor and Clinical Neuropsychologist
Department of Neurological Sciences
Rush University Medical Center
Chicago
IL
Disclosures
BB declares that he has no competing interests.
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- Mild cognitive impairment (MCI)
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