Table 2.
Recommended Initial Screening Tests for Evaluation of a Rapidly Progressive Dementia
| Category | Required Tests | Sometimes Helpful |
|---|---|---|
| Blood tests | CBC | Cancer screen |
| Chemistry panel (including calcium, magnesium, phosphorus) | Blood smear | |
| LFTs | Hypercoagulability testing | |
| RPR | Copper and ceruloplasmin | |
| Rheumatological screen (ESR, ANA, and CRP) | Methylmalonic acid levels | |
| Additional rheumatological tests | ||
| Thyroid function | Coagulation profile | |
| Anti-thyroglobulin and anti-thyroperoxidase antibodies | ||
| Vitamin B12 | ||
| Homocysteine | ||
| HIV | ||
| Lyme | ||
| Paraneoplastic/autoimmune antibodies | ||
| Urine | Urine analysis | Urine culture |
| Copper (24 hours, if Wilson’s disease suspected) | ||
| Heavy metal screen (24 hours) | ||
| CSF | Cell count and differential | Cryptococcal antigen |
| Protein | Viral PCRs and cultures | |
| Glucose | Bacterial, fungal, AFB stains, and cultures | |
| IgG index | Cytology | |
| Oligoclonal bands | Whipple’s PCR | |
| VDRL | 14-3-3 test | |
| Total and phosphorylated tau | ||
| Imaging | Brain MRI (including FLAIR and DWI) with and without contrast | CT head |
| CT chest, abdomen, and pelvis with and without contrast | ||
| Brain angiogram | ||
| Mammogram | ||
| Body PET scan | ||
| MRS | ||
| Carotid ultrasound | ||
| Echocardiogram | ||
| Other tests | EEG | EMG/NCS |
| Brain biopsy (especially if procedures listed earlier are nondiagnostic) |
CBC =complete blood cell count; LFT =liver function test; RPR =rapid plasmin reagin (test); ESR =erythrocyte sedimentation rate; ANA =antinuclear antibody; CRP =C-reactive protein; IgG =immunoglobulin G; HIV =human immunodeficiency virus; CSF =cerebrospinal fluid; VDRL =Venereal Disease Research Laboratory (test); PCR =polymerase chain reaction; AFB =acid-fast bacilli; MRI =magnetic resonance imaging; FLAIR =fluid-attenuated inversion recovery; DWI =diffusion-weighted imaging; CT =computed tomography; PET =positron emission tomography; MRS =magnetic resonance spectroscopy; EEG =electroencephalogram; EMG =electromyogram; NCS =nerve conduction study.