Last reviewed: March 2019
Last updated: September  2018



History and exam

Key diagnostic factors

  • memory loss
  • disorientation
  • nominal dysphasia
  • misplacing items/getting lost
  • apathy
  • decline in activities of daily living (ADLs) 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
  • low IQ
  • traumatic brain injury
  • depression
  • diabetes mellitus
  • female sex
  • elevated plasma homocysteine level
  • cerebrovascular disease
  • hyperlipidemia
  • lifestyle (smoking, obesity, and diet high in saturated fats)
  • less than high school education
  • artificially sweetened soft drink consumption

Diagnostic investigations

1st investigations to order

  • bedside cognitive testing
  • complete blood count
  • 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 RPR/VDRL
  • serum HIV
  • formal neuropsychological testing
  • genetic testing
  • fluorodeoxyglucose-positron emission tomography (FDG-PET)
  • single-photon emission computed tomography (SPECT)
  • Electroencephalogram
Full details

Emerging tests

  • amyloid-positron emission tomography (PET)
Full details

Treatment algorithm



Authors VIEW ALL

Assistant Professor of Psychiatry

Mount Sinai School of Medicine

New York



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 monograph. BRM, ASB, and JKG declare that they have no competing interests.

Peer reviewers VIEW ALL

Medical Director

Kings Harbor Multicare Center

New York



RJG declares that he has no competing interests.

Professor of Neurology

Department of Neurology/Alzheimer Center

VU University Medical Center


The Netherlands


PS declares that he has no competing interests.

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