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Laboratory Tests and Ancillaries
The following laboratory tests may be performed: Complete blood count (CBC), serum electrolytes, liver functions tests (LFTs), renal function tests, glucose test, tests for thyroid function, vitamin B12 and folate levels, and syphilis serology if syphilis is suspected. Electroencephalography (EEG) may be useful in cases where one is considering CJD, those with underlying seizure, or in delirium. Determination of CSF biomarkers, plasma markers, genetic testing and use of genetic marker APOE with or without plasma lipid are not routinely recommended.
Imaging
Neuroimaging, like MRI and CT scans, can help determine dementia subtypes and rule out intracerebral pathology. Structural brain imaging should be obtained in all patients. Brain MRI is the preferred modality to assist with early diagnosis and detect subcortical vascular changes. Brain CT should be obtained if MRI is not available or contraindicated. Brain CT or MRI is recommended in hypertensive patients presenting with cognitive decline to detect silent infarct, a microbleed, or a white matter lesion. Molecular imaging with fluorodeoxyglucose positron emission tomography (FDG PET) may be done to improve diagnostic accuracy in patients with diagnostic uncertainty.