It is well known that MRI has a higher resolution than CT and enables detection of more subtle anatomical and vascular changes [37]; however, a review of 38 studies comparing MRI to CT for investigation of vascular dementia determined that MRI was no more superior in detecting vascular dementia [38]

It is well known that MRI has a higher resolution than CT and enables detection of more subtle anatomical and vascular changes [37]; however, a review of 38 studies comparing MRI to CT for investigation of vascular dementia determined that MRI was no more superior in detecting vascular dementia [38]. a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying A1C42, T- and P- might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural historyhence the need for cost-effective screening measures for early dementia. [26] have reported that informant-based assessments provide greater sensitivity than the MMSE in detecting dementia and changes in biomarker profiles of AD, particularly in the early symptomatic stages. During assessment towards a diagnosis of dementia all aspects of cognitive Etonogestrel function should be addressed and, furthermore, an account of the patients level of education, prior level of functioning, native language, sensory impairments (especially deafness), psychiatric illness and physical disabilities should be ascertained. Key questions that the medical history appraiser should illuminate are the time of onset, speed of decline Etonogestrel and nature of cognitive symptoms. This may give a clue to the potential etiology of the cognitive decline; for example, a rapid cognitive decline is more typical for metabolic disorders, malignancy or prion disease, while the presence of personality changes could allude to the behavioral variant of frontotemporal dementia or traumatic brain injury. Early psychiatric phenomena such as visual hallucinations Etonogestrel are observed in Lewy body dementia. Emphasis on the past medical history is important to assess whether the cognitive disorder is transient or due to a delirium or intercurrent illness. The identification of other neurological problems and head injury are important; the presence of cardiovascular risk factors are vital to exclude vascular causes of MCIvascular dementia being the second most common cause of MCI and dementia in those over 65 years. See Table 2 for a general outline of the clinical differentiation of the common dementias. Table 2 Clinical differentiation of the common dementias. Note: AD: Alzheimers disease; VD: vascular dementia; LBD: Lewy body dementia; FTD: fronto-temporal dementia; PSP: progressive supranuclear palsy; CBD: corticobasal degeneration. thead th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Disease /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Initial Symptoms /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Cognitive Impairment /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Mental State Examination /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Neurological Examination /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Imaging Findings /th /thead ADEpisodic memory lossPredominance of memory loss with later involvement of all cognitive domainsInitially normalInitially normalEntorhinal, cortex and hippocampal atrophyVDSudden onset with stepwise deterioration, falls, apathy, focal weaknessFrontal and executive function, generalized slowing, memory may be sparedApathy, Delusions, AnxietyWeakness, spasticity, focal neurological deficitsCortical and/or subcortical infarctions and white matter diseaseLBDVisual hallucinations, REM sleep disorder, delirium, ParkinsonismDrawing and frontal/executive function Spares memoryDelirium, Visual hallucinations, Depression, DelusionsParkinsonismPosterior parietal atrophy, larger hippocampi than ADFTDApathy, Behavioral and personality change, Poor judgement, Poor speech and languageFrontal/executive, Language, Spares memory and drawingApathy, Disinhibition, HyperoralityMay be normal If overlap with PSP/CBD; vertical gaze palsy, axial rigidity, dystoniaFrontal and or temporal atrophy, Spares posterior parietal lobe Open in a separate window 6.1. Cognitive Testing A number of screening tests for cognitive decline are available and the mini mental state examination (MMSE) is used widely [27]. To screen for a disease implies the use of a highly sensitive, extremely specific test that can be administered at low cost on large populations of healthy individuals with a very accurate positive and negative predictive value. The MMSE is a test that can be completed in 15 minutes which rates cognitive impairment on a scale from 0 to 30. A review of studies designed to assess the diagnostic accuracy of the MMSE showed that a cut-off score of 27 was indicative of MCI, with a sensitivity of 45%C60% and Fzd4 specificity of 65%C90%, while scores less than 26 indicate worse cognitive function [28]. The Montreal cognitive assessment (MoCA) is a screening tool that was specifically designed for the detection of MCI and takes approximately 10 minutes to administer [29]; it has a sensitivity and specificity of detecting MCI at 80%C100% and 50%C76%, respectively, when using Etonogestrel a cut-off of 25/26 [28], which makes it a useful rapid screening test. Furthermore, the realization that the General Practitioner Assessment of Cognition (GPCOG) screen and Mini-Cog testing are as clinically and psychometrically robust as the MMSE.