Initial evaluation of dementia

Abstract

Introduction: Dementia is a growing medical and social problem, more common in the elderly. It estimated that about 92.470 people are affected in Portugal. In spite of its variable clinical presentation, according to the etiology, the diagnostic criteria are very much the same. Alzheimers disease is the main cause of dementia, although many other conditions may cause or simulate dementia. These conditions are often potentially reversible or treatable; thus, the family doctor must be able to perform the diagnosis. Objectives: To describe the recomended steps in the initial evaluation of a possible dementia. Methods: A Medline search from January 1995 to June 2003 using as key words dementia, diagnosis, and primary care was performed. A manual search of neurology textbooks complemented the Medline search. Review: The medical history is an important diagnostic resource in the evaluation of the patient with cognitive deficit. It should include a set of questions to define existing cognitive, behavioural, psychiatric, functional and personality impairments. Physical examination is used not only to confirm the diagnosis, but to eventually identify coexisting illness causing or contributing to the dementia as well. Neurologic examination, mental status examination through the use of tools such as the Mini Mental Status Examination and the Clock Draw Test and the evaluation of functional status. Several conditions may present with memory loss or cognitive deficits; differential diagnosis with delirium, depression and amnestic disturbances must be made. Once the diagnosis of dementia is established investigations must be performed in order to assess the nature of the disorder causing dementia. The main etiologies of dementia are reviewed.