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Diagnosis

Currently, there is no single test that is available to detect and diagnose dementia in clinical practice. Instead the diagnosis of dementia is based on a combination of history taking and physical and neurological exams.  Further investigations, such as lab tests and imaging studies, assist to differentiate the types of dementia.

History Taking Tips

  • build a rapport with the patient and their family/caregivers

  • obtain information on the time of onset, progression, pattern of decline of cognition and function, family history of dementia etc.

  • assess problem solving abilities, behavioural changes and psychiatric symptoms

The interviewer must modify her or his style to accommodate the patient being interviewed.  For example, if the patient has cognitive deficits, the clinician will need to change the style and extent of history taking and interview to the patient’s capacity while respecting boundaries and preserving patient dignity at all times [1].

Obtain permission to talk with other care providers and the family physician if you not the primary care provider yourself.

For more information on how to conduct a proper patient history, consult the Practical Guide to Clinical Medicine Website.[4]

Examination

In the case of dementia a complete examination includes:

  • full physical examination, including neurological exam

  • cognitive assessment including mini mental status examination (MMSE)

For more information on how to conduct full physical and neurological exams, consult the Practical Guide to Clinical Medicine Website[4].

This video reviews the neurological exam in patients with dementia

Dr. Serge Gauthier, 1990, Canadian Study of Health and Aging, Clinical Examination. Approximate running time: 10 minutes

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1. Argonin, Marc E. Dementia Defined. In: Carlat, Daniel J, editor. Practical guides in psychiatry-dementia. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 15-26.

4. University of California, San Diego School of Medicine http://medicine.ucsd.edu/clinicalmed/history.htm accessed: October 4, 2006

All references for this section