Early diagnosis of dementia

Until recently, the most significant issue facing a family physician regard ing the diagnosis and treatment of dementia was ruling out delirium and pot entially treatable etiologies. However, as more treatment options become av ailable, it will become increasingly important to diagnose dementia early. Dementia may be suspected if memory deficits are exhibited during the medic al history and physical examination. Information from the patient's family members, friends and caregivers may also point to signs of dementia. Distin guishing among age-related cognitive decline, mild cognitive impairment and Alzheimer's disease may be difficult and requires evaluation of cognitive and functional status. Careful medical evaluation to exclude treatable caus es of cognitive impairment is important. Patients with early dementia may b enefit from formal neuropsychologic testing to aid in medical and social de cision-making. Follow-up by the patient's family physician is appropriate i n most patients. However, a subspecialist may be helpful in the diagnosis a nd management of patients with dementia with an unusual presentation or fol lowing an atypical course.