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Assessment and investigation of the cognitively impaired adult 

Assessment and investigation of the cognitively impaired adult
Chapter:
Assessment and investigation of the cognitively impaired adult
Author(s):

Jonathan M. Schott

, Nick C. Fox

, and Martin N. Rossor

DOI:
10.1093/med/9780199655946.003.0021
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date: 03 June 2020

A structured assessment of a cognitively impaired adult should aim to reach a specific diagnosis and to establish the impact of any deficits on the individual’s funcion. A detailed history supplemented wherever possible by an informant is the cornerstone of evaluation. A focused cognitive examination can determine the extent and focality of any cognitive deficits. The general and neurological examination can provide useful diagnostic clues, particularly in individuals with young-onset, or multi-system ‘dementia plus’ disorders. All patients with cognitive impairment should have screening blood tests and structural brain imaging which, as well as excluding mass lesions, can provide invaluable diagnostic information based on the presence/pattern of atrophy and signal change. A range of other investigations include functional and molecular imaging and lumbar puncture may be helpful. Once a diagnosis has been reached, a bespoke management plan should be designed, taking into account pharmacological therapies, and support for patient and carers.

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