To meet the criteria for a clinical diagnosis of dementia, three conditions must be met. A person has: 1) new-onset declines in memory and in at least one other cognitive or behavior domain, 2) these deficits must interfere with instrumental activities of daily living (driving, remembering to take medications accurately and managing complex financial matters) and 3) all reversible causes for the decline must be considered and ruled out.
With more than 50 conditions mimicking the symptoms of dementia, an important first step in a gold-standard evaluation of brain functioning is to rule out these potentially treatable causes.
The following eight reversible causes of dementia produce up to 23 percent of symptoms and are easily remembered by the mnemonic DEMENTIA:
Drugs (any drug with anticholinergic activity)
Emotional (depression, anxiety, post-traumatic stress)
Metabolic (thyroid disorders)
Eyes and ears declining
Normal-pressure hydrocephalus (accumulation of cerebrospinal fluid in the brain)
Tumor or other space-occupying lesions
Infection (urinary tract infection)
Anemia (vitamin B12 deficiency)
Once these conditions have been ruled out, a comprehensive dementia evaluation can occur and must include a thorough history including an interview with the person and ideally someone close to them, a detailed review of medical records, neuropsychological evaluation (cognitive pen and paper testing), mood assessment and possible neuroimaging (MRI or CT scan).
A neuropsychologist’s job is integrating the findings from these sources to determine if the person is experiencing normal cognitive aging, a type of mild cognitive impairment, or a subtype of dementia. With over 50 types of dementia, it is critical that we identify what type or subtypes are causing the symptoms (some people have more than one type of dementia) because this is how personalized brain health treatment occurs. Dementia treatment is not a one-size-fits-all approach.