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Dementia Evaluation
WAPA Fall Conference
Thank You
Who is this Guy? More Importantly
• Who are you?
Disclosures
• None
Objectives
• 1. The participant should be able to identify a patient that would benefit from a dementia evaluation.
• 2. The participant should be able to use one of the many dementia evaluation forms available.
• 3. The participant should be able to interpret a dementia evaluation and follow through on the next steps of dementia care.
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Dementia Definition
• Merriam Webster: a usually progressive
condition (as Alzheimer's disease) marked by
deteriorated cognitive functioning often with
emotional apathy
Dementia Definition
• Dementia isn't a specific disease. Instead,
dementia describes a group of symptoms
affecting thinking and social abilities severely
enough to interfere with daily functioning
• Mayo Clinic Website http://www.mayoclinic.org/diseases-
conditions/dementia/basics/definition/con-20034399
Types of Dementia
• Alzheimers
• Vascular dementia
• Dementia with Lewy bodies (DLB)
• Mixed dementia
• Parkinson’s disease
• Frontotemporal dementia
• Creutzfeldt-Jakob disease
• Normal Pressure Hydrocephalus
• Huntington’s Disease
• Wernicke-Korsakoff Syndrome
Why Do We Care?
• Over 4 million individuals in the USA were
diagnosed with AD in 2000 and approx. 13
million sufferers are projected by 2050.
• Hebert L, Scherr P et al, Alzheimers Disease in the US Population Prevalence
Estimates Using the Census; Arch Neurol 2003; 60 (8): 1119-1122 [Pub Med
12925369].
Incidence
• Alzheimer’s Disease
• 4.7 % by age of 70
• 18.2% by age of 80
• 49.6 % by age of 90
• Santacruz, Karen MD & Swagerty, Daniel, MD, MPH, Early Diagnosis of Dementia;
American Family Practice, February 15, 2001. Volume 63 Number 4.
Criteria per DSM V
• Evidence from the history and clinical assessments
that indicates significant cognitive impairment in at
least one of the following:
• Learning and Memory
• Language
• Executive Function
• Complex Attention
• Perceptual Motor Function
• Social Cognition
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Criteria per DSM V
• The impairment must be acquired and represent a
significant decline from a previous level of
functioning.
• The cognitive deficits must interfere with
independence in everyday activities.
• In the case of neurodegenaritive dementia such as
Alzheimer’s disease, the disturbances are of insidious
onset and are progressive, based on evidence from
the history or serial mental-status examinations.
Criteria
• American Psychiatric Association, Diagnostic
and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5), American Psychiatric
Association, Arlington, VA; 2013.
Dementia or Delerium?
Reversible Causes?
• The number of potentially reversible
dementias is upwards to 11%
• Potentially reversible dementias are more
likely to be seen in younger patients ( < 65).
• Scott, Kevin MD, Barrett, Anna, MD Dementia Syndrome: Evaluation and
Treatment, NIH Public Access.
Depression
• Depression can mimic dementia in an
older person and it can always be a
co-morbid condition to dementia.
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Usual Presentations
Family Concern
VS
Self Concern
Initial Workup
• History
• Physical Exam
• Labs
• Imaging (if necessary)
History
• Is this a progressive or acute change?
• What sort of things are they noticing?
• Medication review
Physical Exam
Labs
• CBC
• Comprehensive Panel
• TSH
• Vitamin B 12
Labs
• If clinical suspicion warrants
– RPR
– Lyme’s titer
– Ceruplasmin, arylsulfatase, electropheresis
– Lumbar puncture
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Imaging
• Chest X-Ray
• CT Scan
• MRI/MRA
Mental Status Exams
• MMSE
• MOCA
• Kokmen
MMSE
• Simple to administer
• Fast
• Not a great screening tool for general
population, it should be used for persons at
risk of cognitive impairments. 1
• 1. Tangalos EG, Smith GE, et al. The Mini-Mental State Examination in general
medical practice: clinical utility and acceptance. PMID:8790257 [PubMed- indexed
for MEDLINE]
MOCA
Kokmen What we are trying to do
• All of them test various parts of the brain and
by doing so we can superficially see if there
are any deficits present.
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Clinic Scene
• How I prep the patient and family.
Kokmen
Key Points
• Look for reversible causes of dementia.
• The Mental Status Exams are a tool, not the
tool box.
Lifestyle ?
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Questions? Thank You