Assessment of Cognitive Syndromes

Question 1

Key questions to ask in a history

Answer 1

Affected cognitive domains

• memory
• language
• visual spatial processing
• executive functioning
• attention

Cortical?
-AD => memory but motor intact
Subcortical
-PD => motor but memory intact

Time scale

Long term vs short term memory

Any neurological symptoms
Any medical conditions
Alcohol, smoking
FHx?

Question 2

Possible differentials

Answer 2

AD, VD, DLB, FTLD (behavioural, language (semantic/non fluent)

Alcohol

HIV related neurocognitive disorders

AI/paraneoplastic syndromes

Epilepsy

Systemic illness, medication

Prion disease

Question 3

Investigations

• bloods
• imaging
• others

Answer 3

Blood

• FBC, U%E, LFT, CRP, TFT, B12, folate
• HIV, treponoma (syphillis) serology
• Anti AB - if suspecting AI cause

CTCAP - cancer?
Structural MRI
FDG PET
Amyloid scanning
DATscanning

EEG
Overnight pulse oximetry - sleep disorder?
CSF
-can also immunophenotype, find autoAB, biomarkers

Brain biopsy is rare but done in rapidly progressing dementia where treatable cause is possible

Question 4

Management for treatable conditions

Answer 4

Treat underlying cause

• remove brain tumours
• manage CV risk factors
• stop alcohol
• manage systemic disease
• AI immunosuppression
• CPAP for sleep apnoea

Question 5

Management for neurodegeneration where there is no cure

• medical
• supportive lifestyle

Answer 5

Medical
AD - ACh inh or memantine
FTLD - symptomatic only
PD/LBD - rivastigmine. Ldopa improves motor symptoms but can worsen cognitive symptoms

Non drug

• cognitive stimulation activities
• physical activity, improve diet
• stress, anxiety management
• medication optimisation

Family

• advance decisions, LPAs?
• support for carers important