What Is A Neurological Exam For Dementia

What Does A Neurologist Examine For A Dementia Patient

After taking a careful history of the symptoms, a neurologist will begin with a general physical examination.

Part of this includes the neurologic exam.

A neurologic exam contains six major components mental status exam, cranial nerve exam, motor exam, sensory exam, reflexes, and cerebellar exam.

Abnormalities on the neurologic exam may give the neurologist clues as to what the diagnosis is.

The mental status exam will assess for orientation, attention, memory, visuospatial function, and language. Some common tools are the MOCA and MMSE .

These are a short series of tasks a neurologist may ask you to fill out, and based on how you score, can help in categorizing the types of deficits and hint as to the type of dementia.

Neurology Exam: A Three

A neurologist makes the case for screening every hospitalized patient

WHEN IT COMES to neurologic exams, many are performed only when a patient presents with a particular problem like numbness or vertigo, said S. Andrew Josephson, MD. He directs the neurohospitalist program and chairs the neurology department at University of California, San Francisco .

But at last falls management of the hospitalized patient conference at UCSF, Dr. Josephson argued that hospitalists should masterand usea two- to three-minute screening neurological exam on every patient in the hospital, regardless of the diagnosis that brought him or her in.

Just like you would listen to the heart and lungs of someone who comes in with a stroke, its reasonable to do a basic neurologic exam on everyone to see if anything is going on neurologically, he said. That way, you can capture disorders that otherwise would be missed.

Have the patient walk. Thats the single most useful element in a neurologic exam.

~ S. Andrew Josephson, MDUniversity of California, San Francisco

Dr. Josephson reminded his audience that the neuro exam breaks down into tests for seven separate components: mental status, cranial nerves, motor, reflexes, sensory, coordination and gait. But as part of a screening exam, Id never test reflexes, he admitted, cutting it down to only six elements.

If the extensor is preferentially weak, the pronator teres is going to win, he said.

Preparing For A Neurologist Appointment

• Write down all the questions you would like to ask, like the ones listed in the section below. List your most important questions first. It may be helpful to carry a small notebook or download a smartphone app that will include all your loved ones pertinent care information in one place.
• Make a list of all medications including prescription, over-the-counter and supplements your loved one takes and their dosages.
• Bring along his or her medical history and other paperwork including diagnostic test and lab results, as well as imaging scans like X-rays and MRIs.
• Bring a list of your loved ones other physicians who should have access to their neurology records.
• Ask the neurologist if there are any forms you can complete prior to your visit so you can focus, as much as possible, on keeping your loved one calm and stress-free for the appointment.

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What Are The Types Of Dementia

Dementias are often broken down into two main categories — Alzheimer type or non-Alzheimer type. Dementias of the Alzheimers disease type are defined by the symptoms of memory loss plus impairment in other brain functions, such as language function inability to move the muscles associated with speech or perception, visual or other inabilities to recognize speech or name objects .

Non-Alzheimer dementias include the frontotemporal lobar degenerations, which are further broken down into two main types. One type primarily affects speech. An example is primary progressive aphasia syndromes. The other type is defined by changes in behavior, including lack of feeling, emotion, interest or concern loss of a social filter personality change and loss of executive functions . In both of these frontotemporal lobe dementias, memory loss is relatively mild until later in the course of the disease.

Other non-Alzheimers disease dementias include vascular disorders , dementia with Lewy bodies, Parkinson’s dementia, and normal pressure hydrocephalus.

Assessment By A Specialist

Assessment for dementia by a specialist can be a confusing and daunting prospect. Many memory services offer pre-diagnostic counselling. This is a chance for you to talk things over with a health professional before your assessment. You can choose to have somebody you trust such as a partner, friend or family member with you for this.

The discussion can be an opportunity to share what you already know about dementia, express your wishes and raise any concerns you have about the assessment process. However, if you do not receive counselling before your assessment, you can still ask questions at any time during the assessment process. Having counselling, or asking questions at another point, can help you to:

• understand the reasons why you have been referred
• learn more about the assessment process
• give consent to go ahead with the assessment
• prepare for the possibility of receiving a diagnosis.

You may be asked if you want to know your diagnosis at the end of the assessment process. If you don’t want to find out your diagnosis, the specialist can discuss this with someone you trust instead of with you directly.

The specialist’s assessment may take place at your home or at a hospital. They will gather information about you and your symptoms by:

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Top 8 Types Of Tests For Detecting Cognitive Errors In Patients With Dementia

Cognitive errors are usually observed in patients with dementia. Therefore, most physicians choose to test for these cognitive errors in order to determine with or not their patient has a neurological disorder. Neurologists, neuropsychologists, geriatricians, and geriatric psychiatrists are often employed to conduct these examinations. Here are the 8 most common types of tests physicians can use to detect cognitive errors in patients.

1. Physical Exam

During an appointment for a physical exam, a physician will inquire about their patients diet, alcohol consumption, list of medications, and any general health factors including genetic predispositions or incidents of family health problems they should know about. The doctor may also ask what symptoms or cognitive errors the patient is experiencing, when they began, how often they occur, and whether they have gotten worse over time.

Once the physician is finished reviewing their patients health history, they will start the physical exam part of the appointment. The physical exam may give the physician further insight into what is causing the cognitive errors in their patients. The exam usually entails listening to the patients heart and lungs, checking their blood pressure and pulse, and collecting urine or blood samples for lab testing.

2. Neurological Exam

3. Mental Status Test

Mini-Mental State Exam

Mini-Cog Test

4. Home Screening Test

5. Computerized Test

6. Mood Assessment

7. Brain Imaging

8. Genetic Testing

Who Else May A Person With Dementia See

A person with suspected dementia may come into contact with a range of health and social care professionals. Consultants usually operate within specialist teams, including nurses, psychologists, occupational therapists and social workers. Nurses who work with people with dementia, and those caring for them, include: community mental health nurses , who work in the community, providing treatment, care and support for people with mental health problems and dementia district or community nurses, who provide care and advice for people living at home and practice nurses, who work with doctors in GP practices.

Clinical psychologists, who often work with consultants in memory clinics, assess memory and learning abilities. Occupational therapists can advise people on ways of maintaining their independence including carrying out adaptations and using special equipment. Social workers may be involved in assessing someones need for care services and home care workers may be brought in to help with personal and other care. Physiotherapists may be asked to advise on exercise for people, particularly in the early stages of dementia. Dieticians may be asked to provide guidance on nutrition, poor appetite, weight loss or weight gain.

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What A Doctor May Check And Ask

Most people with suspected dementia will go to a doctors surgery to see their GP. Some doctors, however, will prefer to make a home visit to observe and assess someones behaviour in their own environment. A GP will check a persons blood pressure, temperature and pulse, listen to their heart and lungs and collect blood and urine samples for further tests to be carried out. The doctor will ask what potential signs of dementia have been noticed and when they began, how often they occur and whether they are getting worse.

The GP may ask a series of questions designed to test the persons memory and reasoning skills. The doctor is also likely to carry out a detailed review of any medication taken and ask about personal and family medical history, diet, smoking, intake of alcohol and exercise. The doctor will welcome notes perhaps kept by the patient, a partner, close family member or a care worker that outline when any symptoms or changes first happened. The GP may feel able to make a diagnosis at the conclusion of the assessment or may refer the person to a memory clinic or specialist.

Cultural diversity is an important consideration in the assessment process. Dementia assessments need to be culturally appropriate and recognise the impact of culture on individual behaviour. An interpreter may be vital for a proper assessment.

Dementia Alzheimer’s Disease And Memory Loss

Understandably, discovering that you have trouble with memory and thinking can be worrisome. You want answers and options. At the Cognitive Disorders Program, part of the Department of Neurology at the University of Michigan Health System, our multidisciplinary team of experts has the experience and cutting-edge resources to properly diagnose you and create a treatment plan allowing you the best quality of life possible.

We see patients with a wide variety of cognitive disorders, including:

• Other disorders of cognitive impairment

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What Is Dementia And What Causes It

Dementia is a syndrome that causes a person to develop difficulty and problems with their memory or their ability to think. Unlike the normal changes that happen in a persons memory and thinking over time, dementia affects someones ability to function in their daily life activities and their normal routine .There are different causes of dementia. These causes are typically underlying neurological conditions . One common cause of dementia is Alzheimers disease. Other causes include diseases that impact brain blood vessels. For example, strokes may cause what is commonly termed Vascular Dementia. Some causes include Lewy Body Disease and Parkinsons disease.

Who Can Diagnose Dementia

Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.

If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.

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What Happens During An Assessment For Dementia

This page tells you about the typical steps involved in an assessment for dementia.

Diagnosing dementia is often difficult, particularly if its in the early stages. This is because there isn’t one simple test for dementia and the early symptoms can be similar to those of lots of other common conditions.

There is more than one way that you might end up being assessed for possible dementia. Most people start by visiting their GP because of their symptoms. The process which follows is described as steps 1-4 in this page and ‘Receiving a diagnosis of dementia’.

If you are admitted to hospital, and are over 75 years of age, your assessment may start in hospital. This is because anyone over the age of 75 who is admitted urgently to hospital should now be assessed for confusion and memory problems.

If you visit your GP, even if you are visiting for another reason, they may ask you whether you are worried about your memory. This is because GPs are now encouraged to ask this question to certain patients at increased risk of dementia. You could be included in this group if:

• you have Parkinsons disease
• you have had a stroke or a mini-stroke
• you are over 60 years of age and have diabetes or a heart condition.

If any of these apply to you, and you have been experiencing problems with your memory or thinking, you may need to have a further assessment. This could involve being referred to one of the specialists listed in Step 3.

Signs And Symptoms Of Dementia

• References

Patients often present with concerns of recent memory loss. However, it is not uncommon for a family member to bring these concerns to the physician because some patients deny their impairment or excuse the memory loss as a normal part of aging. The diagnosis of dementia can be suggested when there is an impairment in memory and an impairment of at least one other area of higher cognitive functioning that interferes with normal social and executive functioning in an otherwise alert person.7

Early symptoms that may suggest a dementing illness include difficulty in learning and retaining new information, handling complex tasks, reasoning , and problems with spatial awareness , language , and behavior .6

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Initial Evaluation Of The Patient With Suspected Dementia

ALAN M. ADELMAN, M.D., M.S., Penn State University College of Medicine, Hershey, Pennsylvania

MEL P. DALY, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland

Am Fam Physician. 2005 May 1 71:1745-1750.

• References

Dementia is a common disorder among older persons, and projections indicate that the number of patients with dementia in the United States will continue to grow. Alzheimers disease and vascular dementia account for the majority of cases of dementia. After a thorough history and physical examination, including a discussion with other family members, a baseline measurement of cognitive function should be obtained. The Mini-Mental State Examination is the most commonly used instrument to document cognitive impairment. Initial laboratory evaluation includes tests for thyroid-stimulating hormone and vitamin B12 levels. Structural neuroimaging with noncontrast computed tomography or magnetic resonance imaging also is recommended. Other testing should be guided by the history and physical examination. Neuropsychologic testing can help determine the extent of cognitive impairment, but it is not recommended on a routine basis. Neuropsychologic testing may be most helpful in situations where screening tests are normal or equivocal, but there remains a high level of concern that the person may be cognitively impaired.

Summary of Recommendations

Receiving An Accurate Diagnosis

If you or a loved one is having problems with your memory or other thinking skills , the Sutter Health network of Alzheimers and brain health specialists can help you determine the cause of the problem. Alzheimer’s disease and other types of dementia are defined as a loss of memory and other mental abilities severe enough to interfere with normal daily activities.

Alzheimers disease, while common in older people, is not the only cause of cognitive impairment. There are other forms of dementia, some of which are much milder than Alzheimers. There are also a number of unrelated medical issues that can cause symptoms that look like dementia. Getting an accurate diagnosis is the first step.

The Diagnostic Process

No single test can determine if a person has Alzheimers disease. Our brain health specialists begin with a thorough history and review of your situation and then use a wide range of tools to assess cognitive function and rule out problems that can look like dementia, such as hearing loss and depression. They will also assess for physical issues, such as diabetes or high blood pressure, which can cause vascular changes in the brain and contribute to cognitive changes.

Medical Exam and Laboratory Tests

Neurological Assessment

Neuropsychological Assessment

Imaging Exams and Neurodiagnostics

Additional tests may include:

Health and Wellness

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Neurological Diagnostic Tests And Procedures Fact Sheet

Diagnostic tests and procedures are vital tools that help physicians confirm or rule out a neurological disorder or other medical condition. A century ago, the only way to make a definite diagnosis for many neurological disorders was to perform an autopsy after someone had died. Today, new instruments and techniques allow scientists to assess the living brain and monitor nervous system activity as it occurs. Doctors now have powerful and accurate tools to better diagnose disease and to test how well a particular therapy may be working.

Perhaps the most significant changes during the past 10 years have occurred in genetic testing and diagnostic imaging. Much has been learned from sequencing the human genome and developing new technologies that detect genetic mutations. Improved imaging techniques provide high-resolution images that allow physicians to view the structure of the brain. Specialized imaging methods can visualize changes in brain activity or the amounts of particular brain chemicals. Scientists continue to improve these methods to provide more detailed diagnostic information.

What Are Additional Tests Used To Diagnose Neurological Disorders

The following list of proceduresin alphabetical orderdescribes some of the other tests used to help diagnose a neurological condition.

Angiography is a test that involves injecting dye into the arteries or veins to detect blockage or narrowing. A cerebral angiogram can show narrowing or obstruction of an artery or blood vessel in the brain, head, or neck. It can determine the location and size of an aneurysm or vascular malformation. Angiograms are used in certain strokes where there is a possibility of unblocking the artery using a clot retriever. Angiograms can also show the blood supply of a tumor prior to surgery or embolectomy .

Electroencephalography, or EEG, monitors the brains electrical activity through the skull. EEG is used to help diagnose seizure disorders and metabolic, infectious, or inflammatory disorders that affect the brains activity. EEGs are also used to evaluate sleep disorders, monitor brain activity when a person has been fully anesthetized or loses consciousness, and may be used to confirm brain death.

Individuals may be asked to open and close their eyes, or to change their breathing patterns. Changes in brain wave patterns are transmitted to an EEG machine or computer. An EEG test usually takes about an hour. Testing for certain disorders requires performing an EEG during sleep, which takes at least 3 hours.

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