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STEP 5: Gather history and perform complete physical
exam
➤ Include collateral family/caregiver history.
➤ Avoid "carrying forward" a diagnosis of dementia without an
independent investigation.
STEP 4: Recognize frequency of common types of
dementia
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➤ Alzheimer's dementia: 55-75%
➤ Vascular dementia: 13-16%
➤ Lewy body dementia: 10-25%
➤ Frontotemporal dementia: 5-7%
➤ Parkinson's disease dementia: <1% but occurs in 10% of patients
with advanced PD
➤ Alcohol or AIDS dementia: younger population
Assessment
Table 5. Common Types of Dementia
History Physical Exam
Alzheimer's disease Slowly, progressive cognitive
loss starting with loss of recent
memory and progressing to
loss of executive function,
social function, and ability
to perform activities of daily
living. May be complicated by
neuropsychological symptoms
such as depression, wandering,
agitation, aggressiveness, and
resistance to care.
Unremarkable
Lewy body
dementia
Progressive illness with a
varying pattern of memory
loss. Usually with visual
hallucinations, falls, symptoms
of Parkinsonism, variations in
attention in alertness and rapid
eye movement (REM) sleep
behavior disorder.
Evaluation for ability to attend
to task, visual hallucinations
and rest tremor, bradykinesia,
increased rigidity, orthostatic
hypotension, changes in
personality.
