A complete physical exam for dementia is important to rule out any other underlying medical conditions that could be causing or contributing to the symptoms of dementia. Here is an outline of what a thorough physical exam for dementia evaluation typically includes:
Medical History
The doctor will ask about the person’s medical history, including:
- Current medical conditions
- Past illnesses and surgeries
- Family medical history
- List of medications and supplements
This helps identify any conditions, like thyroid disorders or vitamin deficiencies, that could mimic dementia symptoms. The doctor will also ask about the onset and progression of symptoms.
Vital Signs
The evaluation begins by checking vital signs:
- Blood pressure
- Heart rate
- Temperature
- Respiratory rate
This provides baseline information about the patient’s overall health status. High blood pressure, for example, is a risk factor for vascular dementia.
Physical Examination
A head-to-toe physical exam allows the doctor to identify any abnormalities that require further evaluation. Key elements include:
Head, Eyes, Ears, Nose and Throat
The doctor will check the head and neck for signs of injury, masses, symmetry and range of motion. The eyes are examined for visual acuity, pupil response, and eye movements. Vision or hearing loss can contribute to cognitive problems. The mouth and throat are inspected for sources of infection.
Heart and Lungs
Listening to the heart and lungs can detect arrhythmias, murmurs, or other cardiac conditions. The doctor also checks peripheral pulses. Heart and lung diseases reduce oxygen supply to the brain.
Abdomen
The liver, kidneys and other organs are examined by touch and percussion. Enlarged organs or masses may indicate underlying illness.
Musculoskeletal
The doctor checks muscle strength, tone and coordination, looking for tremors, rigidity, spasticity or other abnormal movements that could indicate neurological conditions. The joints are evaluated for swelling, tenderness and flexibility. Osteoarthritis can contribute to pain and reduced mobility.
Skin
The skin is inspected for rashes, ulcers or other lesions suggestive of illness. Signs of poor nutrition or hygiene may also be evident.
Neurological
A focused neurological exam assesses mental status, speech, sensory function, reflexes, and motor abilities. This identifies specific neurological abnormalities that may underlie dementia symptoms.
Cognitive Assessment
Brief tests of memory, reasoning, attention, language and visuospatial skills are done to gauge mental function. Examples include recalling a short list of words, drawing a clock face, or counting backwards from 100 by 7s. More detailed neuropsychological testing may follow if dementia is suspected.
Psychiatric Evaluation
The doctor asks about mood, sleep patterns, appetite, levels of anxiety or depression. A psychiatric disorder such as severe depression can mimic dementia.
Laboratory Tests
While there are no definitive lab tests for Alzheimer’s disease and most dementias, doctors may order blood and urine tests to look for contributing factors such as:
- Complete blood count and metabolic panel to assess overall health status
- Thyroid, kidney and liver function tests
- Vitamin B12 and folate levels
- Syphilis screening
- Blood glucose level
Brain imaging and spinal fluid tests may also be performed if the diagnosis remains uncertain.
Conclusion
A comprehensive physical examination and clinical workup allows the doctor to thoroughly evaluate an individual for reversible and irreversible causes of dementia. While dementia has no cure, identifying and treating underlying medical conditions can often improve brain function and slow further decline. A complete exam provides the clinical basis for accurate diagnosis and optimum management of this complex disorder.