Physical Examination in the Evaluation of Dementia

Dementia is a common disease worldwide and is largely underdiagnosed. A timely diagnosis of dementia is beneficial for both the patient and family for many reasons, and exclusion and treatment of other mimics of dementia are crucial to avoid long-term consequences. Making a diagnosis of dementia requires attention to subtle cues from both patients and other informants, as often patients and family members will not notice early signs and symptoms. Although universal screening is not recommended by the USPSTF, screening in high-risk populations is recommended by many organizations. Screening with the Mini-Cog and AD8 combined is a highly sensitive way to identify patients with dementia, and confirmation testing can be performed with the MoCA or MMSE. Specific subtypes of dementia, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and others, sometimes can be differentiated by unique physical examination findings. Timely referral to dementia specialists is useful in the management of this group of diseases. However, as the aging population grows and access to specialists is often limited, it is important for all physicians to understand how to make a diagnosis of dementia.