history and examination

Last reviewed 01/2018

Diagnosis of dementia should be made only after through assessment which should include history, cognitive and mental state examination, physical examination, appropriate investigations and a review of medication which might affect cognitive function (1).

The history should be gathered from a person who has known the patient for a period of six months at least and if possible directly from the patient and includes:

  • age
  • medical and psychiatric history of the family e.g. - dementia or other mental health problems (1)
  • origin and progression of condition
  • associations:
    • myoclonus
    • seizures
    • depression, anxiety (1)
  • past and present medical and psychiatric history - e.g. diabetes, hypertension, cerebrovascular accident
  • exposure to toxins:
    • alcohol
    • lead
      • drugs e.g. barbiturates (1,2)

Examination of the demented patient should:

  • exclude dysphasia as a cause for apparent dementia
  • find information about the patient's social functioning which would not be normal in dementia
  • physical examination – to recognize physical disorders which may be responsible for cognitive impairment
    • cardiovascular system – for evidence of CVA
    • neurological examination – to detect focal deficits, gait abnormalities, speech abnormalities
    • endocrine system – signs of hypothyroidism
  • mental state examination – to identify other psychiatric disorders (e.g. – depression) or non-cognitive symptoms that may be associated with dementia (e.g. – delusions, hallucinations) (1)
  • cognitive examination – to estimate the extent of how different cognitive domains  are affected and should include examination of attention and concentration, orientation, short and long-term memory, praxis, language and executive function. Standardised screening tests used for this purpose include (2)
    • 30-item Mini Mental State Examination (MMSE) – commonly used
    • 6-item Cognitive Impairment Test (6-CIT)
    • the General Practitioner Assessment of Cognition (GPCOG)
    • 7-Minute Screen
    • the clock drawing test – to assess praxis and executive function (1)
  • investigations
    • FBC
    • urea and electrolytes
    • blood sugar
    • thyroid and liver function test
    • B12 and folate levels
    • lipid profile (3)