Evaluation of the Patient with Dementia
| Routine Evaluation | Optional Focused Tests | Occasionally Helpful Tests |
|---|---|---|
| History | Psychometric testing | EEG |
| Physical examination | Chest x-ray | Parathyroid function |
| Laboratory tests | Lumbar puncture | Adrenal function |
| Thyroid function (TSH) | Liver function | Urine heavy metals |
| Vitamin B12 | Renal function | RBC sedimentation rate |
| Complete blood count | Urine toxin screen | Angiogram |
| Electrolytes | HIV | Brain biopsy |
| CT/MRI | Apolipoprotein E | SPECT |
| RPR or VDRL | PET | |
| Lab screen for autoantibodies | ||
| Diagnostic Categories | ||
| Reversible Causes | Irreversible/Degenerative Dementias | Psychiatric Disorders |
| Examples | Examples | Depression |
| Hypothyroidism | Alzheimer's | Schizophrenia |
| Thiamine deficiency | Frontotemporal dementia | Conversion 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 | ||
| Depression | Agitation | |
| Seizures | Caregiver “burnout” | |
| Insomnia | Drug 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).