[Clinical investigation of cognitive dysfunction by specialists]

The clinical investigation of the cognitively impaired, or demented, patient includes a clinical bedside examination supported by, for instance, structural and functional brain imaging, analyses of biochemical markers, and genetic analyses. Valuable discussions have been held during the last decade between specialists and primary care physicians to define the clinical elements that should be included in bedside examinations carried out by general practitioners. The present paper is focused instead on the bedside investigation performed by the specialist in the field. Emphasis is put on the importance of combined cognitive and neurological assessments to determine symptoms and syndromes that possibly reflect regional pathological changes in the brain. The article also stresses the importance of detecting possible behavioural and psychological signs of dementia, and the importance of collecting information on the premorbid personality of the patient.