Initial evaluation of suspected dementia - Asking the right questions

The initial clinical approach to suspected dementia involves asking the rig ht questions of the patient and a knowledgeable family member or caregiver. These questions should focus on the nature of the cognitive problem (eg, t he onset, duration, and severity of memory difficulties). The clinical inte rview is supplemented with thorough examination of the patient's physical, neurologic, mental, and functional status. Once a diagnosis of dementia is established, the underlying cause should be identified by a standardized wo rkup, including laboratory testing and, in most cases, neuroimaging. Geneti c testing for the APOE epsilon 4 allele can help confirm the diagnosis in p atients with late-onset familial or sporadic Alzheimer's disease.