Diagnosis of Dementia

How to make diagnosis of dementia?

Dementia is characterized by the presence of impaired cognition, function and behavior, resulting in interference with work, daily activities and social. Diagnosis is based on history, physical examination and neuropsychological assessment. History / interview include disease onset (acute / chronic), disease (stable / progressive, improved), age at onset occurred, general medical and neurological history, changes neurobehaviour, psychiatric history, history-related etiology (such as infections, nutritional deficiencies , drug use, and family history). The physical examination includes vital signs, general examination, neurological and neuropsychological examination. Investigations include laboratory and radiological examinations.

A. Anamnesis

        Interview of the disease should be performed on patients and their day-to-day direct contact with the patient (caregiver). The most important note is the history of cognitive impairment, especially compared to the previous. Onset (sudden / progressive slow) and a change in behavior and personality. 
1. General Medical History 

Dementia can be secondary to many diseases, so please note a history of chronic infections (eg HIV and Syphilis), endocrine disturbances (hyper / hypothyroidism), diabetes mellitus, neoplasms, smoking, heart disease, collagen disease, hypertension, hyperlipidemia and atherosclerosis . 
2. Neurological History 

Need to find the etiology such as a history of cerebrovascular disorders, head trauma, CNS infections, epilepsy, cerebral tumors and hydrocephalus. 
3. History Cognition Disorders

History of cognitive impairment is an important part of the diagnosis of dementia. History momentary memory impairment, short-term and long-term; impaired spatial orientation, time and place, thing, or a comprehensive impaired): impaired executive function (including organization, planning and execution of an activity), impaired praxis and visuospacial. In addition, any questions about daily activities, such as doing work, managing finances, preparing daily necessities, hobbies implement and follow social activities. In this regard, it should be considered by education and social culture.
4. Behavior and personality disorders History

Psychiatric symptoms and behavioral changes are common in patients with dementia. This needs to be distinguished from purely psychiatric disorders, such as depression, schizophrenia, especially the paranoid type. In patients with dementia can be found neuropsychological symptoms such as delusions, hallucinations, miss-identification, depression, apathy and anxiety. Behavioral symptoms may be traveling without a destination (wandering), agitation, physical and verbal aggression, restlessness and dis-inhibition. 
5. A history of intoxication 

A history of intoxication should be asked of aluminum, mercury, pesticides, insecticides, alcoholism and smoking. Medical history, especially of chronic use of antidepressants and narcotics.
 6. Family History 

History of dementia, psychiatric disorders, depression, Parkinson's disease, Down syndrome and mental retardation.

Physical examinationDementia is a syndrome consisting of symptoms of global cognitive disturbance is not accompanied by impaired level of consciousness, but coupled with the nature of the changes that may develop suddenly or gradually to everyone of all ages. A general physical examination, conducted as usual in clinical practice. Neurological examination: Judging the high intra-cranial pressure, focal neurological disorders such as walking impairment, impaired motor, sensory, autonomic, coordination, visual disturbances, abnormal movement / apraxia and the  pathological and primitive reflexes.