Last reviewed: 2 Feb 2021
Last updated: 09 May 2019
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
- low IQ
- traumatic brain injury
- depression
- female sex
- elevated plasma homocysteine level
- cerebrovascular disease
- hyperlipidemia
- lifestyle (smoking, obesity, diet high in saturated fats, and alcohol consumption)
- less than high school education
- artificially sweetened soft drink consumption
Diagnostic investigations
1st investigations to order
- bedside cognitive testing
- CBC
- metabolic panel
- serum thyroid-stimulating hormone (TSH)
- serum vitamin B12
- urine drug screen
- CT
- MRI
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
Treatment algorithm
ONGOING
Contributors
Authors
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.
Disclosures
BRM, ASB, and JKG declare that they have no competing interests.
Peer reviewers
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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