Alabama Brief Cognitive Screener (ABCs)

They’re 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 that may result in cognitive impairment” * Rule out cerebrovascular disease detect segmental atrophy of neurodegenerative syndromes * “Practice Parameter: Diagnosis of Dementia” (Knopman et al, Neurology 2001:56:1143-53)

What is segmental atrophy? Duara et al, Neurology 2008:71:1986-92

Most Common Cause of Dementia

Aging and Preclinical Alzheimer’s disease Sperling et al. Alzheimer’s and Dementia, 2011;7:280-92.

Mild Cognitive Impairment due to Alzheimer’s disease Biomarker evidence of Aβ deposition (by PET or CSF) OR Evidence of Neuronal injury (MRI, CSF, or FDG-PET) NIA-AA criteria, 2011

Dementia due to Alzheimer’s disease- Insidious onset Clear-cut history of worsening of cognition Amnestic: most common, impaired learning and recall of recently learned information AND ≥ 1 other cognitive domain Nonamnestic: Language presentation: most prominent Visuospatial presentation: spatial cognition, including object agnosia, impaired face recognition, simultanagnosia, and alexia. Executive dysfunction: impaired reasoning, judgment, and problem solving. NIA-AA 2011 Criteria

DSM-V Criteria for Major Neurocognitive Disorder Due to Alzheimer’s 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, American Psychiatric Association, 2013.