The patient may echo the examiner’s speech (echolalia) or actions (echopraxia). The content of thought is often impoverished in dementia, but careful AP24534 questioning will reveal the presence of delusions or depressive ideas and the patient may elaborate on psychotic experiences. Affective symptoms are often found in association with dementia and may be the Inhibitors,research,lifescience,medical presenting feature – agitation, anxiety,

irritability are pointers. Disorders of perception occur frequently in people with dementia, and features suggestive of visual or auditory- hallucinations will be apparent from the history – it is not uncommon to see a person hallucinating in the presence of the examiner. Specific questioning will reveal psychotic symptoms such as paranoid ideas or misidentifications. Assessment of cognitive function is greatly aided by using a standard test such as the Mini-Mental State Examination (MMSE).9 The MMSE is scored

Inhibitors,research,lifescience,medical out of 30 points, of which 10 are given for orientation in time and place and the remainder for tests of attention, registration, recall, language, manipulating information, and praxis. It has been Inhibitors,research,lifescience,medical suggested that a cutoff of 23 or 24 on the MMSE is a satisfactory – discriminator between cognitive dysfunction and normality. The MMSE is a useful screening instrument in clinical assessment, but is not a substitute for a full history and mental state examination.(Figure 1). The MMSE is a useful screen in patients referred with a possible dementia. It is quick and easy to complete and sensitive to changes over Inhibitors,research,lifescience,medical time, with an expected decline of approximately 3 points each year in a patient with AD. Figure 1. Mini-Mental State (M.F. Folstein). Reproduced from ref 9: Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician.

J Psych/atr fies. 1975;12:189-198. Copyright (c) 1975, Inhibitors,research,lifescience,medical … A physical examination should be carried out with specific reference to the central nervous system. High blood pressure and focal neurological signs indicate vascular disease. Assessment of vision and hearing is important as impairments may exaggerate cognitive dysfunction. With regard to investigations, there are some TCL that most doctors would recognize as being essential and others that depend on personal experience and, to a certain extent, local availability. Debate surrounds which screening tests are necessary, and some people argue that the low yield of treatable causes of dementia makes such tests superfluous. Investigations that are most useful are minimally invasive and relatively cheap. A standard screen would include full blood count, erythrocyte sedimentation rate, serum B12 and folate, urea and electrolytes, liver function tests, thyroid function tests, and, if there are atypical or unusual features, serological tests for syphilis.