Chest x-ray and an electrocardiogram are indicated if suggested by abnormalities on clinical examination. Lumbar puncture is rarely carried out,

but is indicated if there is any evidence of infection or encephalitis. Computed tomography scanning is the radiological investigation of choice to exclude intracranial lesions, with magnetic resonance imaging indicated for a more detailed assessment of cerebral structures. Single photon emission computed tomography can reveal deficits in blood flow and is particularly helpful in diagnosing frontal lobe dementia. Electroencephalography is sensitive to the confirmation Inhibitors,research,lifescience,medical of the diagnosis of delirium. Assessment instruments for dementia A number of different instruments have been developed to assess various aspects of dementia. A selection is Inhibitors,research,lifescience,medical summarized below, with a more extensive range available in Burns et al.10 Cognitive function Mini-Mental State Examination (MMSE) 9: this is the most widely used test of cognitive function. It

Inhibitors,research,lifescience,medical is scored out of 30, and tests the domains of orientation, language, writing, memory, and praxis. It is reproduced in Table II. Standardized Mini-Mental State Examination (SMMSE)11: this is a standardized version of the Mini-Mental State Examination, which comes with complete rating instructions leading to slightly improved validity. Abbreviated Mental Test Score (AMTS)12 this is a much briefer screening tool, scored out of 10, which tests only orientation and memory. Alzheimer’s Disease Assessment Scale (ADAS)13: this is now a standard cognitive scale used in drug trials. It assesses a number of cognitive functions including memory, language, and practice, and also has a section Inhibitors,research,lifescience,medical devoted to noncognitive features.

Clock Drawing Test (CDT)14-16: this is a relatively new development, is very easy Inhibitors,research,lifescience,medical to administer, and is very popular in primary care because of its simplicity. Global measures Clinical Dementia Rating (CDR)17,18: this is probably the most widely used global scale to give an overall severity rating in dementia, AP24534 ranging from 0 (none), 0.5 (questionable dementia), through mild and moderate to severe dementia. Each is rated in 6 domains: memory, orientation, judgement and problem solving, community affairs, home and hobbies, and personal care. Global Deterioration Scale (CDS)19: isothipendyl this consists of the description of 7 stages of dementia from 1 (normal) to 7, where all verbal ability is lost. The scale has been used extensively and validated with postmortem findings. Psychopathology Cornell Scale for Depression in Dementia (CSDD)20: this is a 19-item scale, which specifically assesses depression in people with dementia in 5 main domains: moodrelated signs, behavioral disturbance, physical signs, cyclic functions, and ideation disturbance.