A19. Examination of the patient with dementia

(No good source, uncertain what it important)
History
- An informant who knows the patient well should be present
  - When did the informant first notice memory loss?
  - How has the memory loss progressed since then?
  - Recent changes in personality or mood?
- Drugs
  - Opioids
  - Anticholinergics
  - Antidepressants
  - Sedatohypnotics (benzos, etc.)
- Which daily activities can the patient perform now compared to previously?
- Medical history
  - Stroke/TIA
  - Cardiovascular disease
  - Diabetes
- Alcohol use
- Sleep status
- Other neurological symptoms
  - Loss of vision
  - Loss of motor function
  - Tremor
  - Poor balance and falls
  - Incontinence
Cognitive testing
- MMSE (mini mental state examination)
- WAIS (Wechsler adult intelligence scale)
Laboratory examination
- B12 deficiency
- Thyroid status
Imaging
- In cases of acute neurologic deterioration
- Head CT or MRI
Neurological physical examination
- Examination for frontal release signs
  - See topic 54
- Ocular examination (topics 2 and 3)
- Examination of gait
- Examination of extrapyramidal symptoms
  - Bradykinesia, rigidity, dystonia, akathisia, etc.
  - -> Dementia with Lewy bodies, Parkinson, vascular dementia, etc.
- Examination of pyramidal signs
  - -> motor neuron disease
- Examination of fundus
  - Papilloedema -> tumour, hydrocephalus