Dementia: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
    • Auscultation (listening) of the heart [due todifferential diagnoses: chronic heart failure (chronic heart failure), cardiac arrhythmias].
    • Auscultation (listening) of the lungs [due todifferential diagnoses: chronic obstructive pulmonary disease (COPD), pulmonary insufficiency (inability of the lungs to provide sufficient oxygen)]
  • If necessary, ophthalmological examination – eye test.
  • If necessary, ENT medical examination – hearing test.
  • Neurologic examination – including motor and sensory function testingNote: Axial rigor (muscle rigidity), clinging, small-step gait, disturbances in vertical oculomotor function (eye movement), dystonic movement disorders, and myoclonias (brief involuntary twitching of single muscles or muscle groups) are indicative of a primary neurodegenerative disease.[due toDifferential diagnoses:
    • Alzheimer’s dementia
    • Chorea-Huntington’s disease (genetic neurological disease with increasing brain mass loss).
    • Encephalitis (inflammation of the brain)
    • Brain tumors
    • Gerstmann-Sträussler-Scheinker disease (disease affecting the brain and associated with BSE).
    • Hallervorden-Spatz syndrome (genetic neurological disorder with mental retardation and early death).
    • Brain abscess (encapsulated collection of pus in the brain).
    • Brain metastases
    • Leigh encephalomyelopathy (genetic neurological disorder of early infancy).
    • Leukodystrophy (disease of the central nervous system characterized by metabolic disorders).
    • Meningoencephalitis (combined inflammation of the brain (encephalitis) and meninges (meningitis)).
    • Parkinson’s disease
    • Multi-infarct dementia (dementia due to brain damage after multiple strokes).
    • Multiple sclerosis (MS) (neurological disease that can lead to paralysis).
    • Multisystem atrophy (neurological disease associated with parkinsonism).
    • Normal pressure hydrocephalus (brain changes due to a decrease in brain matter and a simultaneous increase in cerebrospinal fluid (nervous fluid)).
    • Progressive multifocal encephalopathy (brain changes caused by papovavirus).
    • Progressive supranuclear palsy (neurological disease associated with dementia).
    • Subacute sclerosing panencephalitis (generalized encephalitis (inflammation of the brain) usually caused by measles infection).
    • Wernicke’s encephalopathy (synonyms: Wernicke-Korsakow syndrome; Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain in adulthood; clinical picture: brain-organic psychosyndrome (HOPS) with memory loss, psychosis, confusion, apathy, as well as gait and stance unsteadiness (cerebellar ataxia) and eye movement disorders / eye muscle paralysis (horizontal nystagmus, anisocoria, diplopia)); vitamin B1 deficiency (thiamine deficiency)]
  • Psychiatric examination[due todifferential diagnoses:
    • Alcohol dependence
    • Depression
    • Neuroses
    • Schizophrenia]

    [due topossible sequelae:

    • Depression
    • Hallucinations
    • Insomnia (sleep disturbances)
    • Delusions]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.