Cognitive and

Neuropsychiatric
Examination

- Mini- Mental State Examination (MMSE)

- Montreal Cognitive Assessment (MOCA)
- Cognistat
 - Mini- Mental State Examination (MMSE)

- The mini mental state examination is a cognitive test used to screen for the
presence of cognitive impairment
- A 30 point test with each correct answer scored 1 point
- It is a reliable test, with score:
- Normal: 25- 30
- Mild to moderate: 18-24
- Substantial impairment: 17 or less
- Social background, education level and verbal ability can influence results and
should be taken into account in their interpretation.
 - Mini- Mental State Examination (MMSE)

Areas: - name and state three objects

- orientation
- identify season - recall
- date - remember three objects 5 in
- month later
- year
- floors - language
- hospital - name pencil and watch
- town - repeat
- state - no ifs and buts
- country - follow a 3 step command
- obey a written command
- registration - write a sentence and copy a
design
In AD
- early deficits:
1. episodic memory
2. category generation ( name as many animals in 1 minute)
3. visuoconstructive ability

Verbal or Visual episodic memory- first neuropsychological abnormalities detectetd

Tasks that require the patient to recall a long list of words or a series of pictures
after a predetermined delay

FTD
earliest deficit
1. executive control or langauge (speech or naming) function

PDD/ DLB
severe deficits in visuospatial function
do better : episodic memory tasks
Vascular dementia
executive control + visuospatial deficits with prominent psychomotor slowing

can present with:

depression
anxiety
delusion
disinhibition
apathy

Delirium
most prominent deficits
- attention
- working memory
- executive function
Functional assessment - determine day to day impact of the disorder on the
patient's:
- memory
- community affairs
- hobbies
- judgment
- dressing
- eating
 Neuropsychiatric assessment- important for diagnosis, prognosis and treatment

Early stages of AD:

-mild depressive features
- social withdrawal
- irritability or anxiety
Late stages
- delusions
- agitation
- sleep disturbances

FTD
early and common
- dramatic personality change with apathy
- overeating
- compulsions
-disinhibition
-euphoria
- loss of empathy

DLB
- visual hallucination
- delusions related to person or place identity
- RBD
- excessive daytime sleepiness
 Laboratory tests

American Academy of Neurology

1 CBC
2. electrolytes
3. renal and thyroid function
4. vitamin B 12 level
5. neuroimaging study
MRI- to rule out primary and metastatic neoplasms
locate areas of infarction or inflammation
detect subdural hematomas
suggest NPH or diffuse white matter disease
they also help to establish a regional pattern of atrophy

diagnosis of AD
- hippocampal atrophy
- posterios predominant cortical atrophy
FTD
- focal frontal, insular, or anterior temporal atrophy

DLB
- less prominent atrophy with greater involvement of amygdala than
hippocampus

CJD
- restricted diffusion within the cortical ribbon and or basal ganglia

Vascular etiology
- extensive multifocal white matter abnormalities

NPH
communicating hydrocephalus + vertex effacement
( crowding of drosal convesity gyri / sulci), gaping
sylvian fissures despite minimal cortical atrophy

Single photon emission computed tomography and PET scanning

AD: temporal-parietal hypoperfusion or hypometabolism

FTD: frontotemporal deficits

Amyloid imaging :
Pittsburgh Compound-B (PiB)

F-AV- 45 (florbetapir)
- 25% at age 65

Lumbar puncture- not routinely done

- indicated when CNS infection or inflammation

CSF levels of AB12 and tau proteins

AD- loe AB42 + mildly elevated tau

EEG- not routinely used but can suggest CJD

repetitive burst of diffuse high amplitude sharp waves or "periodic complexes"
underlying nonconvulsive seizure disorder (epileptiform discharges)