chapter  4
26 Pages

Assessment: The Multidisciplinary Approach

ByReinhild Mulligan

Early detection of dementia and in particular of Alzheimer’s Disease (AD) is becoming more important with the development of efficient therapeutic strategies. Aprecise diagnosis at an early stage may give the patient time to come to terms with the disease, to plan the future, and to start treatment when global functioning can still be maintained over a period of time. Assessment of early dementia in clinical practice is complex and usually requires the following steps:

1. Establishing that dementia is present and excluding other possible explanations for symptoms and behavior

2. Determining the type or cause of dementia and the likely prognosis 3. Determining the patient’s current level of disablement in daily liv-

ing, including the effects of co-morbidity 4. Assessing all the resources available 5. Establishing a management plan adapted to the specific needs of pa-

tient and family

In the absence of a biological marker for degenerative dementias, diagnosis must be based on elicited information and analysis of a combination of factors, such as clinical presentation, cognitive profile, complaints and informant reports, neuroimaging techniques, and risk factors. This chapter deals with some important issues in the detection of early dementia, such as memory complaints, changes of cognition in normal cerebral aging, a critical appraisal of the concept of mild cognitive impairment (MCI), possible predictive factors in different types of de-

mentia, the contribution of specialists, and ancillary tests in the overall assessment of these problems.