To make the diagnosis, the clinician must document evidence of intellectual and practical functional decline in:
1. Cognitive function
Decline in short and long term memory and in at least one other area of cognitive function (attention, abstraction, language, praxis, visual-spatial relationships, judgment, and calculations) or personality changes.
Decline and/or interference with work, social and interpersonal activities, or with the ability to function within society.
The decline is not part of a delirium, acute confusional state, and cannot be accounted for by psychiatric illness
More frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something's wrong.
Difficulty performing familiar tasks
All of us occasionally get distracted and leave something on the stove too long or don't remember to serve part of a meal. People with dementia might prepare a meal and not only forget to serve it but also forget they made it.
A complete medical history and physical examination
Neurological and mental status assessments
Investigations: blood and urine, electrocardiogram, electroencephalogram (EEG), lumbar puncture, imaging exam (CT or MRI).
Investigations Lab Work a. CBC, electrolytes and calcium, renal function, VDRL , Thyroid function studies, B12 level, level of oxygenation. b. Consider HIV testing, drug screening, toxin screen, collagen-vascular studies, general biochemical screens Imaging Study a. Duration of cognitive complaints less than 6 months b. Symptom onset before the age of 60 c. Focal signs, focal symptoms, or papilledema d. Diagnosis of a seizure by history, or usual gait abnormalities (e.g.. ataxia or apraxic gait)
Medication-induced dementia is the most frequent cause of "reversible" dementia.
Alterations in pharmacokinetics and pharmacodynamics, together with the presence of concomitant illnesses (especially renal, hepatic, and cardiac) and the number of prescribed medications taken, all make older people more vulnerable to this.
Behavioral problems may appear slowly and change as dementia progresses. The most common problematic behaviors are: agitation; aggression , suspiciousness/paranoia; delusions; hallucinations; insomnia; and wandering