The Role of the Neurologic Examination in Dementia
Nonneurologist practitioners faced with the diagnosis of dementia cannot be expected to conduct the detailed assessments for which neurologists are trained. Nonetheless, they should be able to diagnose the most common forms of neurodegenerative dementia and identify individuals that require more detailed neurologic workup. A neurologic examination algorithm is described that allows the practitioner, in a stepwise and efficient manner, to elicit findings that distinguish the main categories of neurodegenerative and vascular dementia, namely, Alzheimer's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal lobar degenerations. Patients are assessed for gait, frontal signs, signs of parkinsonism, signs of focal or lateralized lesions, neuro-ophthalmologic signs, and signs characteristic of frontotemporal lobar degeneration.

Neurological skill resides in the ability to elicit symptoms and assess the validity of signs that confirm neurodegenerative and cerebrovascular symptoms, and the capacity to adapt the examination to physiologic dysfunction and anatomical lesions at a point in time. From this data, along with evidence about evolution and progression, hypotheses as to the pathology are postulated for confirmation or refutation by subsequent clinical and laboratory testing.

Assessment of the mental state, and to some degree behaviour, is an essential component of the neurologic examination. However, this article addresses the rest of the neurologic exam—the so-called noncognitive neurologic examination.

Neurologists are trained to perform a formal examination which, through experience with numerous disorders of the nervous system, becomes both focused and selectively elaborated to best characterize the disorder under consideration. Other practitioners involved in the care of the neurodegenerative dementias will not have had this experience or the time for this approach yet should be able to make the diagnosis in many, if not most, patients and to decide if referral for formal neurologic assessment is required.