Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

Diagnosis of dementia / assessment of a patient with suspected dementia

History
Mental state examination
Collateral history
Physical examination (including neurological examination)
Investigations

1. History
A. History of presenting complaint
o Onset, duration, progression and impact of symptoms
o Features suggestive of dementia such as:
Chronic or progressive disorder in which there is a disturbance of
higher cortical functions, including memory, thinking, orientation,
comprehension, calculation, learning capacity, language &
judgement
Clear consciousness
o Attempt to distinguish Alzheimers dementia from vascular dementia
Insidious onset in Alzheimers dementia (Vs abrupt onset in
vascular dementia) & slow steady progression over years in
Alzheimers dementia (Vs stepwise as in vascular dementia)
o Features suggestive of frontotemporal dementia
Predominance of frontal lobe features (euphoria, emotional
blunting, coarseness of social behaviour, disinhibition & either
apathy or restlessness)
o Features suggestive of Lewy body dementia
Parkinsonian motor features
Visual hallucinations
Fluctuations in cognitive function with varying levels of alertness
& attention
Sensitivity to antipsychotic (neuroleptic) medication
B. Past psychiatric history
o Previous contact with the psychiatric services
C. Past medical and surgical history
o History of stroke, transient ischaemic attacks with brief impairment of
consciousness, fleeting pareses or visual loss (all of these are risk factors
for vascular dementia)
o Identify other disorders that can cause loss of memory, confusion, attention
deficit or symptoms similar to dementia that include:
Anemia, malnutrition or vitamin deficiencies
Diabetes
Kidney or liver disease
Thyroid abnormalities
Problems with the heart, lung or blood vessels
D. Alcohol and substance misuse history
E. Personal history
F. Family history
o Family history of dementia or other neurological disease
G. Premorbid personality
H. Current medications

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Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

2. Mental state examination

o Appearance & behaviour (impairment of consciousness?, evidence of self-neglect,
restless)
o Speech
o Mood (anxious, depressed)
o Abnormalities of thought (obsessional thoughts, thought disorder, delusions,
suicidal & homicidal thoughts)
o Perception (hallucinations?)
o Cognition (impairment in: memory, orientation, comprehension, calculation,
judgement)
o Insight (does she believe she is unwell & in need of treatment?)

3. Collateral history
o Onset, duration and progression of symptoms
o Ability to carry out activities of daily living (e.g. bathing, grooming, toileting,
eating or more complex activities)
o Prior level of functioning
o Any recent changes in medications, environment and health status
o Assessment of social support system for both the patient and caregiver

4. Physical examination (including neurological examination)

o Evidence of hypertension or stroke (e.g. paresis) vascular dementia
o Focal neurological signs and symptoms vascular dementia
o The exam could show signs of an underlying disease, such as vascular disorders or
vitamin deficiencies. On neurological examination, abnormalities might include
symmetrically abnormal reflexes (frontal lobe release signs). In dementia caused
by vascular disease, multiple sclerosis, or autoimmune conditions, there might be
multifocal findings reflecting abnormalities in several different brain structures.
These might include asymmetrical reflexes, weakness on one side, or
abnormalities in the cranial nerves supplying strength and sensation to the head
and neck.

5. Investigations
o Biological
Bloods: FBC, RFT, LFT, TFT, fasting glucose, B12, folate
ECG, CXR, CT / MRI brain
Alcohol history
MMSE and clock-drawing test
o Psychological
Risk assessment
Neuropsychological testing to identify retained abilities and
specific problem areas, such as comprehension, insight and
judgement.
o Social
Collateral history (from family, GP, psychiatric services including
details of previous risk assessments).
Documentation (GP records, psychiatric case notes)

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Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

Occupational therapy: assessment of the patients activities of daily

living (ADLs) and needs