Dementia Evaluation and Management

Initial Assessment and Diagnosis

The American Academy of Neurology recommends obtaining corroborative history from a reliable informant using validated tools like the AD8, IQCODE, or Quick Dementia Rating System to assess changes in cognition, function, and behavior in patients with suspected dementia 2, 1
Documenting cognitive impairment using standardized screening tools is essential, with tools like the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) being commonly used 1
Assessing functional status to determine if impairments meet dementia criteria is crucial, with basic ADLs affected in dementia and only complex IADLs affected in mild cognitive impairment 3

Core laboratory investigations must include complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, vitamin B12 and folate levels, and liver function tests to exclude reversible causes of dementia 1, 3
MRI of the brain is strongly recommended over CT, particularly for detecting vascular lesions and white matter disease, and can identify medial temporal lobe atrophy, tumors, hydrocephalus, and hemorrhages 1, 3, 2

Evaluating and documenting specific non-cognitive markers, such as gait speed, hearing impairment, sleep history, and neuropsychiatric symptoms, is essential for assessing dementia risk and guiding management 4, 5
Optimizing vascular risk factors, including targeting systolic BP <120 mmHg and ensuring guideline-recommended stroke prevention treatments, can decrease mild cognitive impairment risk 2

Reviewing all medications to identify and minimize anticholinergic or sedative medications that can worsen cognition is crucial 1, 3
Referring to a memory clinic or dementia subspecialist is recommended for patients with atypical cognitive abnormalities, rapidly progressive symptoms, early onset, prominent neuropsychiatric symptoms, or diagnostic uncertainty after initial workup 8, 5, 1
Scheduling follow-up every 6-12 months with serial cognitive assessments to document progression and monitor treatment response is essential, with more frequent visits warranted if behavioral symptoms emerge 3, 8