This chapter discusses the diagnostic evaluation, physical examination, initial diagnostic formulation, investigations, and management of individuals with cognitive and/or behavioral changes. It emphasizes the importance of obtaining a comprehensive history from the patient and an informant, as well as conducting a thorough physical examination. The chapter also provides sample questions for assessing different cognitive domains and lists clues that suggest a non-Alzheimer’s disease etiology of cognitive/behavioral changes. It suggests various diagnostic studies and consultations that may be necessary for each patient. The document highlights the principles of management, including treating reversible causes, minimizing psychoactive medications, promoting regular sleep and exercise, and providing caregiver support. It also discusses the availability of pharmacologic therapies and the importance of providing information and support to families facing dementia-related issues.

A 28-year-old primigravida at 27 weeks’ gestation is referred by her primary care provider to your tertiary center’s high-risk obstetrics unit with a four-week history of worsening exertional dyspnea, marked fatigue with limited daily activities, and a recent syncopal episode, witnessed by her husband. She describes palpitations immediately prior to this brief event. She is asymptomatic at rest and has not experienced chest pain. Her medical history appears non-contributory, and although she practices healthy social habits, she has long-standing exercise intolerance in the non pregnant state with breathlessness after running a few meters.