Dementia Diagnosis and Management

Introduction to Dementia Diagnosis

The Mini-Cog is designed primarily to distinguish between normal cognition and dementia, rather than to detect mild cognitive impairment (MCI) 1
The distinction between MCI and dementia hinges on functional impairment in activities of daily living (ADLs), with MCI criteria requiring preservation of independence in functional abilities and dementia requiring significant impairment in social or occupational functioning 2

A comprehensive diagnostic workup for dementia should include a detailed history from both patient and reliable informant regarding cognitive and functional decline, formal assessment of functional abilities, comprehensive neurological examination, laboratory evaluation to exclude reversible causes, neuroimaging, and assessment of behavioral and psychological symptoms 1, 2, 3
The Pfeffer Functional Activities Questionnaire (FAQ) or Disability Assessment for Dementia (DAD) can be used to assess functional abilities 1
Laboratory evaluation should include tests to exclude reversible causes such as thyroid function, B12, and metabolic panel 3
Neuroimaging, preferably MRI, should be used to evaluate for structural causes and vascular disease 3

While completing diagnostic workup, immediate safety and support needs should be addressed, including assessing driving safety and capacity for independent living, evaluating caregiver burden, and providing education on dementia care 1
Vascular risk factors such as hypertension, diabetes, and hyperlipidemia should be addressed aggressively 3
Once Alzheimer's disease is confirmed, cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine may be considered, which have shown 1-3 point improvements on ADAS-cog, although clinical significance is modest 4, 5, 6