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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