A comprehensive assessment ensures an accurate diagnosis and the collection of baseline information to track changes in a person’s status. Diagnosis should ideally be made by a physician with expertise in diagnosing and treating cognitive disorders such as dementia. An early and accurate diagnosis helps people and their families get timely access to information, advice, and support. It also helps them start treatment earlier, if appropriate, and enables them to plan and make important decisions about their care. If after the comprehensive assessment, the diagnosis still remains unclear, it is important for the physician to organize a plan to arrive at a diagnosis (such as arranging for further testing or referral to a specialist). Clinically indicated care interventions (such as optimizing medications and coordinating necessary supports) should be initiated during this process and not delayed until diagnosis is achieved. Based on the current Canadian clinical practice guideline, structural imaging (e.g., CT and/or MRI) isn’t mandatory in the assessment of a person with cognitive impairment or dementia, but should be obtained if the results would change the clinical management (e.g., if the presence of cerebrovascular disease would result in initiation of specific medications, or where there is suspicion of a mass).
Given the ongoing cognitive decline associated with dementia and the increased risk of people with mild cognitive impairment developing dementia, a comprehensive assessment should be performed when a person first exhibits or experiences changes in cognition, behaviour, mood or function, and on a regular basis afterwards. The person and ideally their family, caregivers, and/or substitute decision-makers should be included in the assessment. The assessment should be culturally appropriate—respectful of diverse cultural, ethnic, and spiritual backgrounds—and in the person’s preferred language.