Alabama Brief Cognitive Screener (ABCs) Theyre impaired, what now?
Screening labs for reversible causes: CBC Electrolytes, glucose, kidney function, liver function thyroid function vitamin B12 level Notably absent: syphilis screening unless they have a specific risk factor Rule out cerebrovascular disease
Neuroimaging Structural Neuroimaging is appropriate to detect lesions thatmay result in cognitive impairment * Rule out cerebrovascular disease detect segmental atrophy of neurodegenerative syndromes * Practice Parameter: Diagnosis of Dementia (Knopman et al, Neurology 2001:56: ) What is segmental atrophy?
Duara et al, Neurology 2008:71: Most Common Cause of Dementia Aging and Preclinical Alzheimers disease
Sperling et al.Alzheimers and Dementia, 2011;7: Mild Cognitive Impairment due to Alzheimers disease
Biomarker evidence of A deposition (by PET or CSF) OR Evidence of Neuronal injury (MRI, CSF, or FDG-PET) NIA-AA criteria, 2011 Dementia due to Alzheimers disease-
Insidious onset Clear-cut history of worsening of cognition Amnestic: most common, impaired learning and recall of recentlylearned information AND 1 other cognitive domain Nonamnestic: Language presentation: most prominent Visuospatial presentation: spatial cognition, including objectagnosia, impaired face recognition, simultanagnosia, and alexia. Executive dysfunction: impaired reasoning, judgment, and problemsolving. NIA-AA 2011 Criteria DSM-V Criteria for Major Neurocognitive Disorder Due to Alzheimers Disease
insidious onset & gradual progression 2 cognitive domains Probable- either: genetic mutation (fmh or test) 1) decline in memory & 1 other cognitive domain, AND 2) steady progression, AND 3) no evidence of mixed etiology Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, AmericanPsychiatric Association, 2013.