1. Alabama Brief Cognitive Screener (ABCs)

2. 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

3. 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: )

4. What is segmental atrophy?
Duara et al, Neurology 2008:71:

5. Most Common Cause of Dementia

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

7. 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

8. 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

9. 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.