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In most cases, the appearance of dementia symptoms is clearly linked to a known head injury. The health care provider will ask for a detailed account of the onset of symptoms. This account should include the following:

• The exact nature of any injury and how it happened, if known
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• Medical attention received in the period immediately after the injury: Hospital emergency room or other medical records should be available.
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• The person’s state since the injury
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• A description of all symptoms and their timing and severity
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• An account of all treatment undergone since the injury
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• Whether any legal action is pending or under consideration

The medical interview will ask for details of all medical problems now and in the past, all medications and other therapies, family medical history, work history, and habits and lifestyle.

• In most cases, a parent, spouse, adult child, or other close relative or friend should be available to provide information that the head-injured person cannot provide.
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• At any time in this evaluation process, the primary health care provider may refer the head-injured person to a neurologist (specialist in disorders of the nervous system, including the brain).

A thorough physical examination will be done to identify neurological and cognitive problems, problems in mental or social function, and unusual appearance, behavior, or mood.

• The examination probably will involve tests of the person’s mental and emotional states. These involve answering the examiner’s questions or following simple directions.
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• Many health care providers refer head-injured persons for neuropsychological testing. This is the most reliable way to document cognitive impairments following head injury.

Neuropsychological testing

Neuropsychological testing is the most sensitive means of identifying dementia in persons with head injury. It is carried out by a specialist trained in this specific area of clinical psychology. The neuropsychologist uses clinical rating scales to identify subtle cognitive problems. This testing also establishes clear baselines for measuring changes over time.

Imaging studies

Head injury warrants a brain scan to detect which parts of the brain are injured.

• CT scan is a type of x-ray that shows details of the brain. It is the standard test in a person who has had a head injury. A scan performed 1-3 months after injury may detect damage not visible immediately after the injury.
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• MRI is more sensitive than CT scan in demonstrating certain types of injury.
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• Single-photon emission computed tomography (SPECT) scan is a relatively new imaging method that is still being studied in people with head injuries. It may be better than CT scan or MRI in detecting functional problems in the brain. SPECT is available only at some large medical centers.

Other tests

Electroencephalogram (EEG) measures the electrical activity of the brain. It may be used to diagnose seizures.

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