Investigations
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Guide de pratique clinique pluridisciplinaire relatif à la collaboration dans la dispense de soins aux personnes âgées démentes résidant à domicile et leurs aidants prochesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017Multidisciplinaire richtlijn voor thuiswonende oudere personen met dementie en hun mantelzorgersPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 20171st investigations to order
FBC
Test
Performed to rule out other causes of cognitive decline such as anaemia.
Result
normal
erythrocyte sedimentation rate
Test
Performed to rule out an inflammatory condition or vasculitis as the cause of cognitive decline.
Result
normal
blood glucose level
Test
Performed to rule out diabetes as the cause of cognitive decline.
Result
normal
renal and liver function tests
Test
Performed to rule out liver or renal failure as the cause of cognitive decline.
Result
normal
vitamin B12
Test
Performed to rule out vitamin B12 deficiency as the cause of cognitive decline.
Result
normal
folate
Test
Performed to rule out folate deficiency as the cause of cognitive decline.
Result
normal
thyroid function
Test
Performed to rule out hypothyroidism as the cause of cognitive decline.
Result
normal
MRI brain
Test
Defines the site and type of vascular lesions in the brain.[66] Absence of cerebrovascular lesions is against a vascular aetiology for the dementia. Imaging is also useful to exclude other potentially treatable aetiologies such as hydrocephalus or tumour.[65][67][68]
Result
cerebrovascular lesion
ECG
Test
Atrial fibrillation increases the risk for embolic cerebral ischaemia.
Other abnormalities such as bundle-branch blocks or ventricular hypertrophy are more non-specific findings of underlying cardiac disease that may reflect common risk factors for atherosclerotic disease.
Result
atrial fibrillation may be present
neuropsychological testing
Test
Neuropsychological assessment is required for most patients to identify patterns of strengths and weaknesses in cognitive performance. The pattern of cognitive impairment is only moderately predictive of the diagnosis of vascular dementia. Identifying patterns of strengths and weaknesses in cognitive performance can be used to establish a baseline for future assessment of cognitive retention and decline.
May not be needed for patients in whom the temporal relation between stroke onset and onset of cognitive symptoms is definite from the history.
Result
poor attention, executive function, retrieval memory deficit, loss of spatial function
Investigations to consider
syphilis serology
Test
Performed in high-risk patients to rule out neurosyphilis as the cause of cognitive decline.
Result
normal
lupus anticoagulant, antiphospholipid, and antinuclear testing
Test
Performed in selected patients to rule out other causes of cognitive decline such as lupus vasculitis or prothrombotic conditions: for example, in atypical cases such as young people with recurrent strokes.
Result
normal
carotid duplex ultrasound
Test
Indicated for patients with dementia caused by cortical infarction. Carotid stenosis of >70% is generally thought to be significant but lower-grade stenoses (50% to 70%) may be important if the patient is symptomatic, especially if ulcerated plaques are present.
In the absence of acute focal neurological symptoms, there is no value in doing a carotid duplex.
Result
normal or carotid stenosis
echocardiogram
Test
Indicated for patients with dementia who have brain imaging suggesting multiple infarcts consistent with embolism: for example, those with multiple cortical bilateral stroke, cardiac arrhythmia, or cardiac failure. In the absence of these, echocardiogram is usually not helpful.
Result
normal or valve vegetation and/or patent foramen ovale
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