Laboratory and Imaging Studies

Traditionally recommended laboratory studies include a complete blood count (CBC), urinalysis, chemistry panel, thyroid-stimulating hormone (TSH) and vitamin B12 levels, and, if concerns are raised in the history, a syphilis serology. These studies have relatively low yield relative to defining the cause of dementia, but they can be helpful to document the severity of comorbid conditions. They also provide a convenient assessment of the patient's nutritional status. Routine use of apolipoprotein (apo) E genotyping and cerebrospinal fluid (CSF) studies are not recommended for routine use. Structural imaging with non-contrast-enhanced CT or magnetic resonance imaging (MRI) is appropriate in the early evaluation of patients with dementia. Imaging may reveal treatable conditions such as benign or malignant brain tumors or subdural hematomas or suggest normal-pressure hydrocephalus (NPH). Functional imaging remains a research tool and is not recommended in the routine dementia evaluation (Knopman et al., 2001).

Referral for formal neuropsychological testing or EEG can be useful for difficult patients. A systematic evaluation provides a basis for more precise patient and family education, aids in prognostication, and may guide therapy. It can help overcome patient and family denial and decrease "doctor shopping." Box 48-6 summarizes conditions the clinician should consider when approaching a patient with suspected dementia.

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