Last reviewed: 27 Sep 2021
Last updated: 26 Aug 2021

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 neurologic signs
  • impaired gait and balance

Risk factors

  • age >60 years
  • obesity
  • hypertension
  • cigarette smoking
  • diabetes mellitus
  • hypercholesterolemia
  • alcohol misuse

Diagnostic investigations

1st investigations to order

  • CBC
  • 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
  • neuropsychologic testing
  • carotid duplex ultrasound
  • echocardiogram

Treatment algorithm

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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