Acquired progressive cognitive decline affecting ≥1 domain with functional impairment; Alzheimer commonest.
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • MMSE / MoCA / ACE-III
- • CBC, TSH, B12, folate, RFT, LFT, calcium, glucose
- • HIV, syphilis serology if risk
- • CT/MRI brain
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat reversible causes
- • Donepezil / rivastigmine / galantamine for mild–moderate AD
- • Memantine for moderate–severe
- • Manage behavioural symptoms non-pharmacologically first
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Capacity assessment, advance care planning, carer support, driving
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
