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Neurological signs of possible diagnostic value in the cognitive disorders clinic
  1. A J Larner
  1. Correspondence to Dr Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK; a.larner{at}thewaltoncentre.nhs.uk

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Introduction

Cognitive impairment, sometimes amounting to dementia, may accompany many neurological disorders1; thus, any neurological sign2 might, in theory, be associated with a cognitive deficit. However, in practice, only a few are relevant because of the limited number of conditions that typically present to cognitive disorders clinics. In addition to these textbook (canonical) neurological signs, a number of others that are easily observed and categorised may help in deciding whether there is cognitive impairment or not. These signs, therefore, also merit inclusion here; indeed, they are discussed first, since in practice, the differentiation of cognitively healthy and cognitively impaired individuals should precede any further investigations.

This article does not presume to be exhaustive, but focuses on those signs that I have found useful in practice. Clearly, any neurological examination must follow a detailed history in order to contextualise any examination findings.

The pattern of neuropsychological deficits evident on cognitive testing, either performed by the neurologist3 or more formally by a neuropsychologist, may help more than neurological signs in establishing an aetiological diagnosis.

Non-canonical signs

Many referrals to the cognitive disorders clinic—possibly an increasing number following high-profile directives on dementia (whether in consequence or subsequence)—are of cognitively healthy individuals with memory complaints, a group variously labelled as worried well, memory complainers, or those with subjective memory impairment. This heterogeneous group includes healthy people intuiting the memory inefficiency which we all will develop with ageing (perhaps from the mid-40s onwards4), as well as those with mood disorders or sleep impairment. Clinical assessment must try to identify these individuals, and to differentiate them from those harbouring the early stages of a neurological disorder, so that they may be appropriately reassured.

The following easily observed and categorised signs, not generally found in neurological textbooks, may help this initial differentiation of the cognitively …

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