Comprehensive Laboratory Evaluation for Dementia Patients

Introduction to Laboratory Testing

• A comprehensive laboratory evaluation, including complete blood count, comprehensive metabolic panel, thyroid function tests, vitamin B12 and folate levels, is essential for all dementia patients to identify potentially treatable causes that could worsen cognitive decline, as recommended by the Alzheimer's Association 1

Routine Laboratory Tests

• The following laboratory tests should be ordered routinely for all patients with dementia: complete blood count (CBC), comprehensive metabolic panel, thyroid function tests (TSH), vitamin B12 and folate levels, to assess electrolytes, glucose, renal function, liver function tests, and identify anemia, infection, hypothyroidism, or hyperthyroidism 1
• Medication levels, cardiac markers, and C-reactive protein should be checked if necessary, with the American College of Cardiology recommending a thorough medication review 2

Special Considerations for Specific Populations

• For patients with Down syndrome and intellectual disabilities, additional testing should include thyroid function tests, screening for celiac disease, and evaluation for obstructive sleep apnea, due to higher prevalence of hypothyroidism and other comorbidities 3

Neuroimaging

• MRI is preferred over CT due to higher sensitivity for vascular lesions and structural abnormalities, with recommended sequences including 3D T1 volumetric sequence, fluid-attenuated inversion recovery (FLAIR), T2 or susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI), as recommended by the American Academy of Neurology and American College of Radiology 1
• The American College of Radiology recommends MRI brain dementia protocol as the preferred neuroimaging method for evaluating dementia, providing superior detection of vascular lesions, structural abnormalities, and atrophy patterns that help differentiate between dementia subtypes and guide clinical management 4, 1
• Semi-quantitative scales, including MTA (Medial Temporal Lobe Atrophy) scale, Fazekas scale, and GCA (Global Cortical Atrophy) scale, should be used for standardized interpretation of MRI findings, as recommended by the Alzheimer's and Dementia society 1

Clinical Evaluation

• Vital signs with orthostatic blood pressure measurements should be taken, as they are a significant predictor of falls in dementia, with the American Geriatrics Society recommending regular orthostatic vital sign measurements 2
• A neurological examination focusing on focal deficits, extrapyramidal signs, and gait and balance assessment should be performed, with the American Academy of Neurology recommending a thorough neurological examination 2
• A brief cognitive assessment to establish current status and compare to baseline, and an assessment of functional abilities to determine the impact of the fall, should be performed, with the American College of Physicians recommending a comprehensive functional assessment 1
• An evaluation for delirium using a standardized tool should be performed, with the American Psychiatric Association recommending a thorough evaluation for delirium 1

Medication Review

• A medication review for drugs that increase fall risk, such as psychotropics, antihypertensives, sedatives, and anticholinergics, should be performed, with the American Geriatrics Society recommending a thorough medication review 2

Imaging Guidelines