Clinical assessment in dementia

In the past, symptoms of dementia were easily dismissed as ‘just old age’, but with the availability of treatment for some forms of dementia, an accurate diagnosis is more important than ever. Dementia, however, can be difficult to diagnose, where only through a thorough assessment can it be determined whether the patient has dementia and whether their symptoms conform to a particular pattern. We have set out the structure of a comprehensive clinical assessment of someone suspected of having dementia. When assessing a patient with cognitive impairment it must always be considered that the patient may have delirium or depression. The most vital part of the assessment is history-taking, from both the patient and also from a close informant as, depending on the degree of cognitive impairment present, the amount and accuracy of information given by the patient will vary. It is important to explore all the details of the difficulties the patient is having and identify which cognitive domains may be impaired to have caused them. The clinician must also have an array of bedside cognitive tests to support his or her suspicions of cognitive impairment from the history taken. Investigations, including blood tests and radiology, are used to exclude comorbid physical illnesses which may be partially, or rarely completely, reversible for the cognitive symptoms. A good clinician is aware of the limitations of the investigations and knows when it is appropriate to use them.