Early Dementia Screening
Abstract
:1. Introduction
2. Definition: Early Dementia
Criteria | MCI | Mild AD |
---|---|---|
Evidence of performance | Objective evidence of poorer performance in one or more cognitive domains greater than expected for the patients age and educational background | Objective evidence of poorer performance in more than one cognitive domain such as memory, language, visuospatial or executive function |
Interference with daily activities | Limited interference with daily activity; however, complex functional tasks may be completed less efficiently, e.g., preparing meals, shopping alone for clothes and groceries, planning a day’s activity, remembering appointments or paying bills | Significant interference in being able to function effectively at work or during usual activity; however, still able to carry out less complex activity, e.g., ADLs—bathing, dressing and grooming and IADLs—completing chores or attending social functions |
3. Diagnostic Criteria
- Memory complaint, usually corroborated by an informant
- Objective memory impairment for age
- Essentially preserved general cognitive function
- Largely intact functional activities
- Not demented
4. Subtypes
5. Epidemiology
6. Clinical Evaluation
6.1. Cognitive Testing
Disease | Initial Symptoms | Cognitive Impairment | Mental State Examination | Neurological Examination | Imaging Findings |
---|---|---|---|---|---|
AD | Episodic memory loss | Predominance of memory loss with later involvement of all cognitive domains | Initially normal | Initially normal | Entorhinal, cortex and hippocampal atrophy |
VD | Sudden onset with stepwise deterioration, falls, apathy, focal weakness | Frontal and executive function, generalized slowing, memory may be spared | Apathy, Delusions, Anxiety | Weakness, spasticity, focal neurological deficits | Cortical and/or subcortical infarctions and white matter disease |
LBD | Visual hallucinations, REM sleep disorder, delirium, Parkinsonism | Drawing and frontal/executive function Spares memory | Delirium, Visual hallucinations, Depression, Delusions | Parkinsonism | Posterior parietal atrophy, larger hippocampi than AD |
FTD | Apathy, Behavioral and personality change, Poor judgement, Poor speech and language | Frontal/executive, Language, Spares memory and drawing | Apathy, Disinhibition, Hyperorality | May be normal If overlap with PSP/CBD; vertical gaze palsy, axial rigidity, dystonia | Frontal and or temporal atrophy, Spares posterior parietal lobe |
6.2. Functional Status
6.3. Review of Medications
6.4. Neurological Evaluation
6.5. Psychiatric Evaluation
6.6. Social History
6.7. Additional Testing
6.8. Final Assessment
7. Possible Treatments
7.1. Anticholinesterase Inhibitors
7.2. Monoclonal Antibody Treatment
Solanezumab
7.3. Tau
7.4. Non-Pharmacological Treatments
7.4.1. Exercise
7.4.2. Cognitive Training
8. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Panegyres, P.K.; Berry, R.; Burchell, J. Early Dementia Screening. Diagnostics 2016, 6, 6. https://doi.org/10.3390/diagnostics6010006
Panegyres PK, Berry R, Burchell J. Early Dementia Screening. Diagnostics. 2016; 6(1):6. https://doi.org/10.3390/diagnostics6010006
Chicago/Turabian StylePanegyres, Peter K., Renee Berry, and Jennifer Burchell. 2016. "Early Dementia Screening" Diagnostics 6, no. 1: 6. https://doi.org/10.3390/diagnostics6010006
APA StylePanegyres, P. K., Berry, R., & Burchell, J. (2016). Early Dementia Screening. Diagnostics, 6(1), 6. https://doi.org/10.3390/diagnostics6010006