Laboratory Studies

All patients with dementia should have laboratory testing to rule out reversible causes of dementia.

CBC, electrolytes, thyroid-stimulating hormone (TSH), folate, and vitamin B-12 levels should be obtained. The American Academy of Neurology no longer recommends syphilis screening in the routine evaluation of dementia if patients come from geographic regions with a very low base rate of syphilis. In specific cases, screening for syphilis is indicated.

If the clinician has reason to suspect an angiitis affecting cerebral vessels, then an erythrocyte sedimentation rate (ESR) and specific panels may be ordered.

Imaging Studies

Patients with newly diagnosed dementia undergo neuroimaging studies to rule out treatable causes of dementia and to aid the differential diagnosis.

Either CT scanning or MRI of the head should be performed.

In patients with vascular dementia, multiple cortical, and more commonly subcortical, infarcts or single strokes affecting the thalamus, angular gyrus, and the territory supplied by the anterior cerebral arteries are observed.

Decreased white matter density (on CT scanning) or decreased T1 or increased T2 signal intensities (on MRI) are associated with dementia. Multiple pathologies, including small vessel disease and decreased integrity of the blood-brain barrier, have been associated with these findings.

Measurement of cerebral blood flow using single photon emission computerized tomography (SPECT) or positron emission tomography (PET) scanning is not recommended for diagnostic purposes.

Treatment & Management

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Author

Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jaime Grutzendler, MD Assistant Professor, Department of Neurology and Physiology, Northwestern University School of Medicine

Jaime Grutzendler, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience

Disclosure: Nothing to disclose.

Giovanni d'Avossa, MD Lecturer, School of Psychology, Bangor University; NHS Honorary Consultant in Neurology

Disclosure: Nothing to disclose.

Fredy J Revilla, MD, FAAN, FANA Clinical Professor, University of South Carolina School of Medicine, Greenville; Chief, Division of Neurology, UMG Neuroscience Associates, Prisma Health-Upstate

Fredy J Revilla, MD, FAAN, FANA is a member of the following medical societies: American Academy of Neurology, American Neurological Association, Huntington Study Group, International Parkinson and Movement Disorder Society, Parkinson Study Group, Society for Neuroscience

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge C Kattah, MD Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

Christopher Luzzio, MD Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.