Fast Five Quiz: Alzheimer's Disease

Helmi L. Lutsep, MD

Disclosures

May 06, 2022

A complete physical examination, including a detailed neurologic examination and a mental status examination, should be performed to evaluate disease stage and rule out comorbid conditions. A complete neurologic examination is performed to look for signs of other diseases that could cause dementia, such as Parkinson's disease or multiple strokes. In patients with Alzheimer's disease, the neurologic examination findings are typically normal, other than anosmia. Anosmia is also found in patients with dementia with Lewy bodies, Parkinson's disease, and TBI (with or without dementia).

Initial mental status testing should include evaluation of:

  • Attention and concentration

  • Recent and remote memory

  • Language

  • Praxis (ie, ability to perform skilled motor tasks without nonverbal prompting)

  • Executive function

  • Visuospatial function

Cognitive features of early Alzheimer's disease include memory loss, mild anomic aphasia, and visuospatial dysfunction. At all subsequent follow-up visits, a full mental status examination should be performed to evaluate disease progression and identify the development of any new neuropsychiatric symptoms.

Brief standardized examinations, such as the Mini-Mental State Examination (MMSE), are less sensitive and specific than longer batteries that are specifically tailored to individual patients. Other examples include the Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS) examination. Nonetheless, screening examinations have a role, particularly as a baseline.

Learn more about screening for cognitive impairment.

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