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Table 182-3

Evaluation of the Patient with Dementia

Routine EvaluationOptional Focused TestsOccasionally Helpful Tests
HistoryPsychometric testingEEG
Physical examinationChest x-rayParathyroid function
Laboratory testsLumbar punctureAdrenal function
Thyroid function (TSH)Liver functionUrine heavy metals
Vitamin B12Renal functionRBC sedimentation rate
Complete blood countUrine toxin screenAngiogram
ElectrolytesHIVBrain biopsy
CT/MRIApolipoprotein ESPECT
RPR or VDRLPET
Lab screen for autoantibodies
Diagnostic Categories
Reversible CausesIrreversible/Degenerative DementiasPsychiatric Disorders
ExamplesExamplesDepression
Hypothyroidism Alzheimer'sSchizophrenia
Thiamine deficiency Frontotemporal dementiaConversion reaction
Vitamin B12 deficiency Huntington's
Normal-pressure hydrocephalus Dementia with Lewy bodies
Subdural hematoma Vascular
Chronic infection Leukoencephalopathies
Brain tumor Parkinson's
Drug intoxication
Autoimmune encephalopathy
Associated Treatable Conditions
DepressionAgitation
SeizuresCaregiver “burnout”
InsomniaDrug side effects

Abbreviations: PET, positron emission tomography; RPR, rapid plasma reagin (test); SPECT, single-photon emission computed tomography; TSH, thyroid-stimulating hormone; VDRL, Venereal Disease Research Laboratory (test for syphilis).