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Perform a diagnostic evaluation and refer the patient for any needed general medical care.

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  • A thorough evaluation is often coordinated with the patient's primary care physician.

  • The evaluation serves to identify the specific etiology of the dementia syndrome that may guide treatment decisions, as well as to reveal any treatable psychiatric or general medical conditions that might be causing or exacerbating the dementia. Components of a basic evaluation are described in Table 1.

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Table 1. Components of a Basic Evaluation for Patients With Dementia

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Table Reference Number
Table 1. Components of a Basic Evaluation for Patients With Dementia
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Neuroimaging

  • The use of a structural neuroimaging study, such as a computerized tomography (CT) or a magnetic resonance imaging (MRI) scan, is generally recommended as part of an initial evaluation, particularly for patients with a subacute onset (less than 1 year), age at onset less than 65 years, vascular risk factors, or possible focal lesion. The value of imaging in patients with late-stage disease who have not been previously evaluated has not been established. Functional neuroimaging using positron emission tomography (PET) may contribute to diagnostic specificity (e.g., to differentiate Alzheimer's disease and frontotemporal dementia).

  • Neuropsychological testing may be helpful to differentiate among dementias, evaluate a patient with subtle or atypical symptoms, characterize the extent of cognitive impairment, establish baseline function, and guide treatment.

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Genetic Testing

  • Except in rare circumstances (notably the use of CSF-14-3-3 protein when Creutzfeldt-Jakob disease is suspected and recent stroke or viral encephalitis can be excluded), biomarkers remain investigational, and there is insufficient evidence for their utility in routine clinical practice. However, this area is evolving rapidly.

  • Genes involved in a small number of dementia syndromes have been identified, and genetic testing for these genes is available commercially or through research studies. However, genetic testing is generally not part of the evaluation of patients with dementia. If testing is obtained, pre- and post-test counseling is recommended.

Table Reference Number
Table 1. Components of a Basic Evaluation for Patients With Dementia

References

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