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| {{CMG}} | | {{CMG}} |
| ==Overview== | | ==Overview== |
| ==History and symptoms== | | == History and Symptoms == |
| The final diagnosis of dementia is made on the basis of the clinical picture, increasingly with neuroimaging results for backup. For research purposes, the diagnosis depends on both a clinical diagnosis and a pathological diagnosis (i.e., based on the examination of brain tissue, usually from [[autopsy]]).
| | * Medication history |
| | | * Abbreviated mental status examination |
| Proper differential diagnosis between the types of dementia (see below) will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there are some brief (5-15 minutes) tests that have good reliability and can be used in the office or other setting to evaluate cognitive status. Examples of such tests include the [[abbreviated mental test score]] (AMTS), the [[mini mental state examination]] (MMSE), Modified Mini-Mental State Examination (3MS)<ref name="pmid3611032">Teng E L, Chui H C. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–18. PMID 3611032</ref>, the Cognitive Abilities Screening Instrument (CASI)<ref name="pmid8054493">Teng E L, Hasegawa K, Homma A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45–58. PMID 8054493</ref>, and the clock drawing test<ref name="pmid9598672>{{cite journal |author=Royall, D.; Cordes J.; & Polk M. |title=CLOX: an executive clock drawing task |journal=J Neurol Neurosurg Psychiatry |volume=64 |issue=5 |pages=588-94 |year=1998 |pmid=9598672 |url=http://jnnp.bmj.com/cgi/content/full/64/5/588}}</ref>.
| | * Thorough history needs to be performed to rule out any underlying disease etiology. |
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| An [[abbreviated mental test score|AMTS]] score of less than six (out of a possible score of ten) and an [[Mini-mental state examination|MMSE]] score under 24 (out of a possible score of 30) suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances (for example, a person in great pain will not be expected to do well on many tests of mental ability).
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| ===Mini-mental state examination===
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| {{main|Mini-mental state examination}}
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| The [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] reviewed tests for cognitive impairment and concluded <ref name="pmid12779304">{{cite journal |author=Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; & Lohr, K.|title=Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force |journal=Ann Intern Med |volume=138 |issue=11 |pages=927-37 |year=2003 |pmid=12779304 |url=http://www.annals.org/cgi/content/full/138/11/927}}</ref>:
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| * [[Mini-mental state examination|MMSE]] | |
| : sensitivity 71% to 92%
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| : specificity 56% to 96%
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| A copy of the [[Mini-mental state examination|MMSE]] can be found in the appendix of the original publication.<ref name="pmid1202204">{{cite journal |author=Folstein MF, Folstein SE, McHugh PR |title="Mini-mental state". A practical method for grading the cognitive state of patients for the clinician |journal=Journal of psychiatric research |volume=12 |issue=3 |pages=189-98|year=1975 |pmid=1202204 |doi=10.1016/0022-3956(75)90026-6}}</ref>
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| ===Modified Mini-Mental State examination (3MS)===
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| A copy of the 3MS is online.<ref>{{cite web |url=http://www.cjns.org/27febtoc/predicting_appendix_.html |title=Appendix: The Modified Mini-Mental State (3MS) |accessdate=2007-09-06 |format= |work=}}</ref> A [[meta-analysis]] concluded that the Modified Mini-Mental State (3MS) examination has:<ref name="pmid17178826">Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment.
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| J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):790-9. Epub 2006 Dec 18. PMID 17178826</ref>
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| : sensitivity 83% to 94%
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| : specificity 85% to 90%
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| ===Abbreviated mental test score===
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| {{main|abbreviated mental test score}}
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| A [[meta-analysis]] concluded:<ref name="pmid17178826"/>
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| : sensitivity 73% to 100%
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| : specificity 71% to 100%
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| ===Other examinations===
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| Many other tests have been studied <ref name="pmid17163083">{{cite journal |author=Sager, M.; Hermann, B.; La Rue, A.; & Woodard, J.|title=Screening for dementia in community-based memory clinics |journal=WMJ |volume=105 |issue=7 |pages=25-9 |year=2006|pmid=17163083}}</ref><ref name="pmid17287448">{{cite journal |author=Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; & Thal L. |title=Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment |journal=Neurology|volume= |issue= |pages= |year= |pmid=17287448}}</ref> <ref name="pmid12614094">{{cite journal |author=Karlawish, J. & Clark, C.|title=Diagnostic evaluation of elderly patients with mild memory problems |journal=Ann Intern Med |volume=138 |issue=5 |pages=411-9|year=2003 |pmid=12614094 | url=http://www.annals.org/cgi/content/full/138/5/411}}</ref> including the clock-drawing test [http://jnnp.bmj.com/cgi/content/full/64/5/588/F3 example form]). Although some may emerge as better alternatives to the MMSE, presently the MMSE is the best studied. However, access to the MMSE is now limited by enforcement of its copyright ([[mini mental state examination |details]]).
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| Further evaluation includes retesting at another date, and administration of other (and sometimes more complex) tests of mental function, such as formal neuropsychological testing.
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| === Associated Conditions ===
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| * Behavioural disorders
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| * [[Delirium]]
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| * [[Delusion]]
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| * [[Depression]]
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| * [[Hallucinations]]
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| === Criteria for Diagnosis ===
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| * [[Amnesia]]
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| * Impairment of abstract thinking
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| * Limited judgment ability
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| * Orientation disturbances
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| * Impairment of higher cognitive functions:
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| *:* Acalculia
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| *:* [[Agnosia]]
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| *:* [[Aphasia]]
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| *:* [[Apraxia]]
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| *:* Personality changes
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| === Severity of Dementia ===
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| * '''Mild''': Independent personal hygiene and judgment are retained, but a reduced performance in social activities or household activities is noticed
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| * '''Medium''': Some monitoring necessary, living independently is dangerous
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| * '''Severe''': Permanent care and monitoring absolutely necessary, serious loss of independence
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| ==References== | | ==References== |
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