Box 2. Clinical evaluation of suspected dementia.

Dementia is identified based on:

• Medical history, including from family, friend, or caregiver, focusing on cognition and function

• Brief outpatient or bedside cognitive examination

• If needed, neuropsychological testing

The etiology of dementia is determined based on:

• Medical history

➢ Neurologic history

➢ General medical history

➢ Family history

• Physical examination

➢ Neurologic signs (e.g., cognitive impairment, focal signs, parkinsonism, other)

➢ Pertinent systemic signs (e.g., for vascular and metabolic diseases)

• Neuropsychological testing

• Laboratory testing

➢ Thyroid function and vitamin B12 level

➢ Other tests as indicated, such as for metabolic, infectious, autoimmune, and other etiologies*

• Structural brain imaging with CT or MRI

➢ AD: generalized or focal cortical atrophy, often asymmetric (hippocampal atrophy)

➢ Vascular contributions to cognitive impairment and dementia: brain infarcts or white matter lesions

➢ Frontotemporal dementia: frontal lobe or anterior temporal lobe atrophy

➢ Other abnormalities such as brain mass (e.g., tumor) and hydrocephalus

• Referral to a specialist, for additional neurologic and medical testing, if specific etiologies suspected

➢ Brain tests: electroencephalogram [EEG]

➢ Vascular tests: head and neck magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA)

➢ Cardiac tests: electrocardiogram [ECG], echocardiography, ambulatory cardiac rhythm monitoring

^*Depending on the clinical presentation, consider blood tests for a CBC, ESR, chem 7 which includes a glucose level, renal and liver function tests, folic acid, and a RPR.