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Diagnostic Evaluation
Based on evidence from extensive literature review, the NINCDS-ADRDA (1997) states that the DSM-III-R definition is reliable and should be used as the practice guideline.
The DSM-III-R states:
The essential feature of Dementia is impairment in short-and long-term memory, associated with impairment in abstract thinking, impaired judgement, other disturbances of higher cortical function, or personality change. The disturbance is severe enough to interfere significantly with work or usual social activities or relationships with others. The diagnosis of Dementia is not made if these symptoms occur...in Delirium...(Knopman, 2001)
More Information: http://www.aan.com/public/practiceguidelines/md_summary.htm
Thorough and case-specific client history
- Client interview
- Detailed history as applicable to client (corroborated with caregiver)
- Current/focused history - patterns of losses, current functioning, safety concerns, onset of memory and other cognitive problems
- Past medical history - risk factors, head trauma, neurological conditions
- Geriatric review of systems - driving, falls, continence, constipation, vision and hearing, dental, neurologic symptoms
- Depression screening is considered a recommended practice guideline by the NINCDS-ADRDA
- Social and family history
- Review of medications - prescription and OTC
- Review of preventive interventions - immunizations, appropriate age-related screenings
- Advance healthcare directive status - expressed wishes, chosen surrogate.
- Cognitive Screening
http://www.guideline.gov
http://www.ahrq.gov/clinic/3rduspstf/dementia/dementrr.htm
- Neuropsychiatric testing - may want to refer for a complete battery depending on the case and extent of the disease process; is of value in confirming the presence of dementia when the diagnosis is in doubt, in clarifying dementia type, and in differentiating dementia from mental illness, including depression.
- Caregiver/family interview
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Examination
- Complete physical exam
- Include comprehensive neurological exam
- Functional status - ADL's (Activities of Daily Living)
- Include or schedule other case specific tests such as gait and balance
Laboratory Evaluation
Rule-out metabolic imbalance and/or other underlying issues that may be contributing to the problem
- Complete Blood Count
- Comprehensive Metabolic Profile
- Drug levels as appropriate to medications
- B12 Level
- Thyroid Profile
- RPR - recommended only if there is specific risk or evidence of prior syphilitic infection
- Optional - Sedimentation Rate, folate, HIV, UA, urine heavy metals, toxicology screen
Radiographic evaluation/Neuroimaging Tests - also case specific for appropriateness. Consider the following questions before proceeding:
- How much burden, psychologically, physically, and financially, will a neuroimaging test place on the patient?
- How likely is it that a treatable lesion will be found in this patient?
- How likely is it that treating the lesion will make a difference in the clinical course?
- How important is it to the patient and/or family that the diagnosis be as certain as possible, regardless of the likelihood of a treatable lesion?
- *CT scan of the brain - without contrast will detect hydrocephalus and most clinically significant mass lesions, infarcts, and subcortical ischemic changes
- *MRI of the brain
- EEG - if seizures are a consideration or to distinguish potential Alzheimer's (slow wave) from severe depression (normal waves)
*Considered a recommended practice guideline by the NINCDS-ADRDA.
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For research references: Resources | For more information: Useful Links
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