Welcome back, actually in this situation first off a MRI should be done again, this will allow us to determine have any changes occurred since the last MRI and whether those changes are consistent with dementia or MS. Secondly, the dementia should be graded on the basis of physical examination and questionarres. These would include the mini mental state examination MMSE or MOCA tests. In addition depression should be ruled out as a cause which can sometimes mimic this problem. This can be done by the geriatric depression scale, Once these are done then the following tests can be considered,
Urinalysis and microscopy
Complete blood cell count
Serum electrolyte levels, including magnesium
Serum chemistry panel, including liver function tests
Thyroid function tests
Serum vitamin B12
Erythrocyte sedimentation rate
Serologic tests for syphilis (or similar)
These can help narrow down the cause for the dementia by excluding most reversible causes for the problem. If a reversible cause is found then it should be treated accordingly. The MRI of the brain would help us to determine if vascular or lewy body dementia are present or if it is another cause.
Regarding follow up it would need to be with the same clinical tests to determine if it is progressing or not.
But yes a baseline should be established.
Do you have any more questions?
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