Diagnostic Criteria and Management of Dementia

Diagnostic Criteria

The American Academy of Neurology recommends that cognitive or behavioral symptoms must interfere with ability to function at work or usual activities, represent a decline from previous levels of functioning, and not be explained by delirium or major psychiatric disorder, with assessment through history-taking and objective cognitive evaluation 1
Cognitive impairment must be detected through history-taking from patient and knowledgeable informant, plus objective cognitive assessment, according to the American Academy of Neurology 1, 3
Key cognitive domains affected include memory impairment, impaired reasoning and handling of complex tasks, visuospatial abilities impairment, language function impairment, and changes in personality or behavior, as stated by the American Academy of Neurology 1

The American Academy of Family Physicians recommends using standardized cognitive assessment tools, such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), to generate scores that can be tracked over time 4, 5, 6
The MMSE has high sensitivity and specificity for moderate dementia, while the MoCA is more sensitive for mild cognitive impairment, according to the American Academy of Neurology 6, 3

The American Geriatrics Society recommends cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, for mild to moderate dementia, as they can delay clinical decline and benefit cognitive function 6
Memantine is recommended for moderate to severe dementia and can be used alone or as add-on therapy with cholinesterase inhibitors, according to the American Geriatrics Society 6

The American Academy of Neurology recommends prioritizing non-pharmacological approaches, especially for behavioral and psychological symptoms of dementia, including cognitive training, physical exercise, music or art therapy, and reminiscence therapy 6

The American Academy of Family Physicians recommends ruling out conditions that mimic dementia, such as depression, metabolic disturbances, medication effects, and sleep disorders, as they can cause similar symptoms or co-occur with early dementia 4, 5
Regular follow-up every 6-12 months is recommended to track disease progression and reassess cognitive, functional, neuropsychiatric, and behavioral symptoms, according to the American Academy of Neurology 2