Diagnosis of dementia

The need for an accurate diagnosis of dementia and the 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 be established only pathomorphologically, whereas in other cases, for example, in case of dementia caused by toxic brain damage, no diagnostically significant pathomorphological changes are detected.

Various diagnostic criteria have been developed for the diagnosis of dementia. For example, the criteria DSM-IV and NINCDS / ADRDA (National Institute of Neurologic, Communicative Disorders and Stroke / Alzheimer's Disease and Related Disorders Association) exist for the diagnosis of Alzheimer's disease. Diagnostic criteria of DSM-IV are based on population studies and expert consensus, the NINCDS / ADRDA criteria were developed by a working group of experts that established uniform criteria for research purposes. The use of common diagnostic criteria makes it possible to compare and generalize the results of the Study1 obtained by different authors.

The identification of the cause of dementia is of paramount importance, for the solution of which, in addition to anamnesis and examination of the patient, a thorough somatic examination is required. The minimum program of somatic examination in a patient with dementia includes:

1. Total number of blood cells.
2. The level of electrolytes.
3. Screening of metabolic disorders.
4. Research of the functional state of the thyroid gland.
5. The content of B12 and folic acid in the blood.
6. Serologic research on syphilis and AIDS.
7. Analysis of urine.
8. ECG.
9. Radiography of the chest.

Examples of other studies include: MRI, PET, single-photon emission computed tomography (SPECT), lumbar puncture for liquor research, induced potentials of various modalities, dopplerography of the main vessels of the head, and other methods, including brain biopsy (rarely). In even more rare cases, the final diagnosis of the cause of dementia is established only on the basis of a histopathological study of the brain.

Neuropsychological studies include testing functions such as orientation in place and time, memory, language evaluation, tests for assessing praxis, attention, perception, social functions, household activity.

MMSE is very popular. It is a short scale of the Mini-Mental State Examination, which measures points in time, place, and perception, attention and account, memory, speech functions.

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

Examination of patients with dementia

The examination of patients with dementia is conducted in accordance with practical recommendations developed on the basis of expert consensus. It includes careful collection of anamnesis with elucidation of the history of the development of symptoms, the transferred diseases and surgical interventions, psychological features and characteristics of the patient's development, family and social circumstances. It is important to establish which pharmacological agents or phytotherapeutic drugs (on the prescription of the doctor or on their own) were taken or received by the patient, whether it was treated by unconventional methods, whether alcohol or psychoactive substances were used, and at what doses, whether it suffered craniocerebral trauma, epileptic seizures, urinary incontinence, motor and behavioral disorders. Interrogating the patient, you need to assess the condition of all organs and systems.

Neuropsychological examination reveals disturbed and preserved cognitive functions, which allows you to clarify the diagnosis and outline 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 this case. Studies of blood serum and urine can confirm the presence of infection, endocrine disorders, impaired renal and hepatic function, violations of water-electrolyte balance, blood diseases, vitamin deficiency. The examination complex also usually includes ECG and chest X-ray. People with an increased risk of sexually transmitted diseases are being tested for HIV and syphilis. It is important to consider that the moment of infection can be amnesed by patients. Methods of neuroimaging (CT and MRI) can reveal a volumetric process, hematoma or stroke. In certain cases, methods of functional neuroimaging (positron emission tomography, single-photon emission computed tomography, functional MRI), as well as CSF and EEG, may be useful. The purpose of the psychosocial survey is to assess the formal (from the social services) and informal support of the patient and establish understanding between the patient and those caring for him, which facilitates the implementation of the treatment plan. Functional examination assesses the state of everyday activity and instrumental daily activity. In addition, it is necessary to discuss in full the problems of the safety of the daily life of the patient, taking into account the possibility of wandering, the danger of driving a car or leaving the included cooker unattended and other actions that put the life of both the patient and others at risk. Ideally, information from the patient should be corroborated by information received from close people who should also be involved in the development of a treatment plan.

Differential diagnosis of dementia

The complex approach described above to the examination of the patient helps in establishing the diagnosis. Active research makes it possible to reliably exclude the possible association of cognitive impairment with a curative somatic and neurological disease or toxic effect, the elimination or adequate treatment of which can improve the state of cognitive functions.

[1], [2], [3], [4], [5], [6], [7],