Pharmacologic approaches can provide modest symptomatic relief. For treatment, patients benefit from non-pharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as family gatherings. Additional evaluation with cerebrospinal fluid assays or genetic testing should be considered in atypical dementia cases, such as age of onset under 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. For example, focal neurologic abnormalities suggest stroke. Physical examination may help identify the etiology of dementia. However, if the assessment is inconclusive (e.g., symptoms present, but normal examination), neuropsychological testing can help with a diagnosis. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a moderately extended mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. However, dementia is commonly associated with more than one neuropathology, usually AD with cerebrovascular pathology. In the US, Alzheimer’s disease (AD) affects 5.8 million people. Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function.
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