While all memory changes or complaints in later life do not signal Alzheimer's disease, serious memory difficulties are not an unavoidable part of normal aging. The purpose of the clinical workup is to rule out other disorders which may involve similar symptoms. Likewise, symptoms of dementia may be improved when other problems (medical, psychological) are corrected although the underlying dementia remains.

The clinical exam should include a focused history, a physical exam, and functional and mental status evaluations. The history can be given by the patient, but it is advised to have at least one informant who is familiar with the patient also give a history. The patient may not recognize the severity of their own cognitive decline and a more accurate history may be given by the informant. A description of memory problems, chronology of the problems, family history, social history, and medication history should all be included.

The physical exam should pay special attention to identification of conditions that may cause delirium or reversible dementia. A complete neurological examination including sensory and motor systems should be performed. A laboratory workup may rule out infection or metabolic derangements. Although not required, some physicians will request a CT or MRI to rule out suspected disorders such as infarction or tumor. A psychiatric evaluation to rule out depression or other psychiatric disorder may be warranted.

The functional status assessment should also be completed by an informant using the Functional Activities Questionnaire or a similar exam. The mental status assessment, completed by the patient, may involve any of several tests, the most popular being the Mini Mental State Exam (MMSE). Mental status testing is an essential component of the exam and includes specific assessment of orientation, registration, attention, calculation, recent recall, naming, repeating, understanding, reading, writing and ability to draw or copy. The mental status assesments are useful in establishing baseline cognition, and then can detect any decline or improvement when reapplied in the future. However, they cannot stand alone as a diagnosis; it is imperative that the history and physical be considered in addition.