Evaluating Cognitive Complaints

In evaluating a patient with cognitive complaints, the first step is to evaluate whether the patient, in fact has a progressive, significant, global decline in cognitive functioning (Dementia) or not. This is done by first obtaining a history of what sort of problems have been noticed. The next step is to administer cognitive testing of various sorts. These tests can be simple screening tests or may require more in depth and complicated testing, depending on the severity of the problems.

Since several conditions may mimic Dementia (especially depression) (Things that Mimic Dementia) we also routinely screen for depression in evaluating patients with cognitive complaints, as well as reviewing their medications.

If a diagnosis of Dementia is made, further testing is then performed to evaluate the specific cause of the Dementia (Causes of Dementia). These tests include a neurological examination, lab tests (in particular blood count, liver tests, vitamin B12 level, thyroid tests, calcium level, electrolytes, kidney tests), and some sort of brain imaging study (usually a CT scan but sometimes an MRI). If all tests are normal, and the progression is otherwise typical, the diagnosis is Alzheimer's Disease.