Dementia diagnosis

The need for accurate diagnosis of dementia and establishment of its cause is dictated by differences in prognosis and approaches to treatment for dementias of different genesis. In some cases of dementia, a reliable diagnosis can only be established pathomorphologically, while in other cases, for example, in dementia caused by toxic brain damage, diagnostically significant pathomorphological changes are not detected.

Various diagnostic criteria have been developed to diagnose dementia. For example, for diagnosing Alzheimer's disease, there are the DSM-IV and NINCDS/ADRDA (National Institute of Neurological, Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association) criteria. The DSM-IV diagnostic criteria are based on population studies and expert consensus, while the NINCDS/ADRDA criteria were developed by a working group of experts who established uniform criteria for research purposes. The use of uniform diagnostic criteria makes it possible to compare and generalize the results of Study 1 obtained by different authors.

Identifying the cause of dementia is a task of primary importance, which requires, in addition to anamnesis and examination of the patient, a thorough somatic examination. The minimum program of somatic examination of a patient with dementia includes:

1. Total blood cell count.
2. Electrolyte levels.
3. Screening for metabolic disorders.
4. Study of the functional state of the thyroid gland.
5. Blood levels of B12 and folic acid.
6. Serological testing for syphilis and AIDS.
7. Urine analysis.
8. ECG.
9. Chest X-ray.

Examples of other studies include: MRI, PET, single-photon emission computed tomography (SPECT), lumbar puncture for CSF examination, evoked potentials of various modalities, Doppler ultrasonography of the great vessels of the head, and other methods, including brain biopsy (rarely). In even rarer cases, a definitive diagnosis of the cause of dementia is established only on the basis of histopathological examination of the brain.

Neuropsychological studies include testing of such functions as orientation in place and time, memory, language assessment, tests for assessing praxis, attention, perception, social functions, and everyday activities.

The Mini-Mental State Examination (MMSE) is very popular. It assesses orientation in time and place, as well as perception, attention and counting, memory, and speech functions.

The diagnosis of dementia requires the involvement of both a neurologist and a psychiatrist (or neuropsychologist).

Examination of patients with dementia

Examination of patients with dementia is carried out in accordance with practical recommendations developed on the basis of expert consensus. It includes a thorough collection of anamnesis with clarification of the history of symptom development, past illnesses and surgeries, psychological characteristics and developmental characteristics of the patient, family and social circumstances. It is important to establish what pharmacological agents or herbal medicines (as prescribed by a doctor or independently) the patient has taken or is taking, whether he has been treated with alternative methods, whether he has consumed alcohol or psychoactive substances and in what doses, whether he has suffered from craniocerebral trauma, whether he has had epileptic seizures, urinary incontinence, motor and behavioral disorders. When interviewing the patient, it is necessary to assess the condition of all organs and systems.

Neuropsychological examination helps to identify impaired and intact cognitive functions, which helps to clarify the diagnosis and develop a treatment plan. Based on the results of a complete physical, neurological and psychiatric examination, it is possible to determine what additional research methods are needed in a given case. Blood serum and urine tests help to confirm the presence of infection, endocrine disorders, renal and hepatic dysfunction, water-electrolyte imbalance, blood diseases, and vitamin deficiency. The examination usually also includes an ECG and chest X-ray. In individuals with an increased risk of sexually transmitted diseases, a test for HIV and syphilis is performed. It is important to take into account that the moment of infection may be amnestic for patients. Neuroimaging methods (CT and MRI) help to identify a volumetric process, hematoma or stroke. In certain cases, functional neuroimaging methods (positron emission tomography, single-photon emission computed tomography, functional MRI), as well as CSF and EEG studies, may be useful. The purpose of the psychosocial assessment is to evaluate the patient's formal (social services) and informal support and to establish a rapport between the patient and his or her caregivers, which facilitates the implementation of the treatment plan. The functional assessment evaluates the state of daily living activities and instrumental daily living activities. In addition, it is necessary to thoroughly discuss the patient's daily living safety issues, taking into account the possibility of wandering, the danger of driving a car or leaving the stove on unattended, and other actions that put the life of not only the patient but also those around him or her at risk. Ideally, information from the patient should be confirmed by information from close people, who should also be involved in the development of the treatment plan.

Differential diagnosis of dementia

The above-described comprehensive approach to patient examination helps in establishing a diagnosis. Active examination allows to reliably exclude a possible connection of cognitive impairment with a treatable somatic and neurological disease or toxic effects, the elimination or adequate treatment of which can improve the state of cognitive functions.

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