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
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.