Screening packages

Focus on early detection and prevention of dementia

Brain Health Ltd.'s next-generation Neurocognitive Center at Liv DMC

Your mind is our mission!

Dementia and neurocognitive disorders

Dementia is a condition that involves the gradual loss of thinking functions (e.g., writing, speaking, reading, counting, orientation, spatial-visual abilities, language skills, attention maintenance) and eventually leads to the loss of social relationships and self-care skills. In 70% of the cases, major neurocognitive impairment (e.g. Alzheimer's disease) is behind the symptoms. In the remaining 30%, reversible causes can be discovered in the background of the complaints (e.g. hormone abnormalities, vitamin deficiency). Dementia most often develops as a result of a combination of lifestyle and genetic factors, but recent research draws attention to the importance of prevention options. Accurate and early diagnostics, followed by an individual risk assessment and a prevention plan based on this, are of paramount importance both in prevention and in appropriate therapy. With proper prevention, dementia can be avoided in almost half of the cases!

About the program

The protocol behind the Brain Health service (Brain Health TreeTM) was created by Prof. Dr. Anita Kamondi PhD, DSc, Dr. András Attila Horváth PhD, Dr. Gábor Csukly PhD and Dr. Péter Kovács PhD (see Board Members). Through their decades of research, they have developed an examination system in cooperation with the world's leading centers, which covers the detailed analysis of important risk factors in the development of dementia and is suitable for the early diagnosis of diseases causing dementia. Through the program, people affected by dementia can receive appropriate drug therapy and lifestyle counselling, while an individualised prevention strategy can be developed for healthy people at high risk of dementia.

6 reasons why you should choose us?

#Vezető team of professionals – Brain Health Ltd is backed by clinicians and dementia researchers who are widely recognised and cited in scientific publications. Our experts participate in the development of the latest international diagnostic recommendations. Our diagnostic and therapeutic recommendations are based on the joint decision of our leading experts (Brain Health CogniTeamTM), thus ensuring that we develop the most optimal personalised prevention and therapy plan after the examination.

#Átlátható and accurate diagnostic protocol – The examination and therapeutic protocol behind the service (Brain Health TreeTM) has been developed after nearly a decade of work, after numerous international study trips, in cooperation with the world's leading dementia centers (see Diagnostic Services). All elements of the examination are specific to dementia, so the reversible causes causing dementia can be detected with a high degree of certainty. The special protocol ensures that no unnecessary tests are carried out and that it is clear to the participant what the next step is based on each result. The test results are interpreted in an integrated way, and all its elements are thoroughly reviewed with the person being examined.

#Egyénre tailored, multi-element prevention plan - Our experts are members of the world's leading cooperation focusing on dementia prevention, the EUROFINGERS consortium (www.eufingers.com). The basis of the prevention system of Scandinavian origin is that it develops a prevention protocol with so many elements (nutrition, exercise, risk reduction, cognitive development) based on the assessment of individual risk factors, which is highly effective in preventing or delaying the onset of dementia symptoms. Our service (Brain Health HelpTM) integrates this knowledge to develop a followable and compliant action plan for the long-term protection of your mind (see Intervention Services).

#Hozzáférés to the latest products and international clinical trials- The past few years have brought a significant breakthrough in the therapy of dementia: in addition to symptomatic drugs, preparations that affect the actual cause of the disease have also appeared. At the same time, it became clear that these and the new drugs that will appear later can only be accessed by those who have been diagnosed with dementia during an examination of the appropriate quality. Our service is in close contact with CRU Global, one of the world's leading clinical trial groups, and a number of health technology, rehabilitation and health prevention companies (see Partners). Through these connections, a fast and effective route opens up for our patients to access the latest products and therapeutic methods.

#Kutatás and medicine – We know that today's medicine is not the same as tomorrow's medicine. For this reason, our service combines patient care with research work in a unique way in private healthcare (see Our Scientific Activity). Our participants have the opportunity to participate in exploratory research that allows them to learn more about their own brain function. Since the prevention of dementia requires a lifelong commitment, the knowledge accumulated from clinical research will increasingly serve the person providing data for it. Our team is constantly following the new results of international medical research and we incorporate them into our diagnostic and therapeutic toolkit.

#Kiemelkedő quality, exclusive health environment and healing conditions - Our clinical center is located in a well-equipped and high-quality medical institution. During care, a multidisciplinary approach is of paramount importance to us, including the joint presence of related professions that play a significant role in cognitive health preservation. Those who turn to us can enjoy the outstanding quality of treatment and prevention in an exclusive environment. In our partner institutions, the balance of healing, research and education is a fundamental value. We pay significant attention to the wide range of social communication of scientific results and new medical recommendations (see Social Communication), so that our patients and their relatives can be widely informed about the current position of medical science.

Who do we recommend it to?

For those who do not have thinking function disorders, but would like to assess their individual risk (read more - Screening package)

For those who have cognitive complaints and would like to have them examined (read more - Diagnostic Package)

For those who have been diagnosed with mild cognitive impairment or dementia and would like to seek clarification and advice regarding their diagnosis and therapy (read more - Differential Diagnostic Services)

For those who would like to know their genetic background in terms of the risk of developing dementia or their chances of inheritance (read more - Genetic Diagnostic Package)

For those who want to take an active role in the prevention of dementia (read more - Intervention Services)

Diagnostic services

Brain Health Screening Package

What does the Screening Package contain?

• Neurological examination: complete medical history, physical examination, review of risk factors
  
  
• Overview of cognitive assessment: neuropsychological pre-screening
  
  
• Cardiovascular examination: overview of risk factors, cervical ultrasound examination

• Cranial MRI scan: contrast-free cranial MRI recorded and found according to a special dementia protocol
  
  
• CogniTeamTM consultation: risk assessment, evaluation, summary discussion

What kind of examinations are taking place, and why are they?

Neurological examination and informative neuropsychological assessment

• Neurological examination plays a key role in the examination of cognitive complaints and dementia screening, as it helps the doctor assess the functioning of the nervous system. An informational neuropsychological assessment examines the disorders of memory, spatial orientation, attention and language skills.

The results of the studies may indicate the involvement of different areas of the brain and may help to distinguish between the neurological diseases underlying the complaints (e.g. Alzheimer's disease, vascular dementia, dementia associated with Parkinson's disease, etc.).

A neurological examination can help rule out other diseases that cause dementia-like symptoms.

The examination will help determine the next tests (see Differential Diagnostic Services), as the primary causes behind the symptoms may vary. Different dementias have different neurological patterns. For example:

• In Alzheimer's disease, memory is often the primary area affected, with no other neurological signs.
  
  
• Lewy body dementia can be associated with visual hallucinations, variable alertness, and symptoms typical of Parkinson's disease.
  
  
• Frontotemporal dementia is characterised by personality changes and early speech disorders.
  

Cranial MRI scan

Cranial MRI (magnetic resonance imaging) is an important tool in the examination and screening of dementia because it provides a detailed picture of the structure of the brain and allows the doctor to identify changes that may be related to cognitive decline. The test is performed according to a special protocol that includes T1, T2, FLAIR, SWI and diffusion sequences, as well as visual scoring (e.g. Koedam scale, Scheltens scale) and AI-assisted volumetric analysis (e.g. hippocampal volumetrics).

The role of cranial MRI in dementia:

1. Detection of cerebral atrophy (atrophy)

• MRI can show atrophy of brain tissue, in particular:
  
  
  • In Alzheimer's disease, atrophy of the hippocampus and medial temporal lobe is characteristic.
    
    
  • In frontotemporal dementia, asymmetric atrophy of the frontal and temporal lobes is observed.
    
    
• The pattern of atrophy can help differentiate between types of dementia.

2. Recognition of vascular lesions

• MRI sensitively indicates small vessel disease, white matter lesions and signs of stroke.
  
  
• These changes may indicate vascular dementia or mixed types of dementia (e.g., Alzheimer's and vascular components together).

3. Exclusion of other diseases

MRI helps rule out brain diseases that can cause cognitive impairment, such as:

• Brain tumors
  
  
• Normal-pressure hydrocephalus (NPH) – typically enlarged cerebral ventricles with normal-pressure cerebrospinal fluid.
  
  
• Chronic hematoma (subdural hematoma)
  
  
• Inflammatory or infectious neurological disorders

4. Confirm and follow up on the diagnosis

• MRI contributes to early diagnosis, especially in atypical cases of dementia.
  
  
• Follow-up MRI scans can be used to monitor the progression of the disease.
  

Overview of cardiovascular risk assessment and cervical ultrasound examination

The role of cardiovascular risk assessment in dementia assessment is of paramount importance because cardiovascular risk factors are closely related to the development of certain types of dementia, especially vascular dementia and mixed dementia (when Alzheimer's disease and vascular damage are present).

Proper brain function requires a continuous and uninterrupted blood supply. If blood circulation is impaired, such as due to narrowed or blocked blood vessels, high blood pressure, or heart problems, it can contribute to:

• Microinfarctions, white matter damage
  
  
• For ischemic damage (oxygen deficiency)
  
  
• For the acceleration of cerebral atrophy in degenerative diseases

The aim of cardiovascular risk assessment in dementia is:

1. Identification and management of risk factors

• The risk of dementia is increased by a number of cardiovascular factors (e.g. high blood pressure, high cholesterol, etc.).

Early detection and treatment of these conditions can slow or prevent cognitive decline. It can be especially effective in middle-aged people, but it is also useful in older age. Risk estimation is carried out using anamnestic data, thorough questioning of the patient, evaluation of test results, and special scoring systems.

• Ultrasound examination of cervical vessels in the examination of dementia is primarily aimed at assessing the state of cerebral circulation. Although it does not diagnose dementia on its own, it is an important complementary test, especially if there is a suspicion of vascular dementia or mixed-type dementia.

What is an ultrasound examination of the cervical vessels?

It is a non-invasive imaging procedure used to examine the condition of the carotid arteries. These blood vessels are crucial for the blood supply to the brain.

Carotid ultrasound detects atherosclerotic plaques or vasoconstrictions, which,

• can cause reduced cerebral blood flow,
  
  
• promote the development of small vessel diseases or microinfarctions,
  
  
• contribute to the development of vascular dementia.
  
  
• It helps to recognise a high risk of stroke, which is especially important because stroke can also cause dementia.
  

Who do we recommend the Brain Health Screening Package to?

For people who do not have cognitive complaints, but would like to assess their individual dementia risk.

For people who have cognitive complaints and would like to start examining them.

What can happen after the test?

The primary goal of the study is to screen for people at risk of cognitive decline. If your tests do not reveal a suspicion of a neurological and/or dementia-causing disease, we will recommend a repeat screening according to your age (e.g. over the age of 65, we recommend repeating the screening every 3 years). If we identify a neurological or neurosurgical disease that is not associated with dementia, we recommend a consultation with a neurology or neurosurgical specialist, which we are happy to help you arrange. If the suspicion of a disease causing dementia is confirmed, we recommend using the Brain Health Diagnostic Package.

In addition, we offer the opportunity to participate in clinical drug trials specific to the given disease, if such a study takes place during the given period.

How much does the package cost?

Gross 370.000 Ft.

How to arrive for the examination, and what is the procedure of the examination?

In the screening package, the neurological and cardiovascular examination is preceded by a cranial MRI (see Skull MRI), for which you will receive an appointment. The evaluation of the examination takes about 1 week, after which you will receive an appointment for a neurological and a review neuropsychological examination. Bring a list of your medications, vitamins, and dietary supplements to the examination. If you have had medical examinations, laboratory tests, and their results within 1 year, please bring them with you. It is possible to come to the examination with a close relative. The examination takes about 1 hour, followed by a 30-minute cervical ultrasound examination. The results are evaluated as a team-based decision, at a weekly joint meeting of its leading experts (CogniTeamTM). You will receive an electronic notification of the result. You will then have the opportunity to consult your results and next steps with a senior service professional (CogniTeamTM member) in person or online as part of the package.

Brain Health Diagnostic Package

What is included in the Diagnostics Pack?

• Comprehensive ophthalmological examination: medical history, physical examination
• Overview of audiological examination: medical history, physical examination
• Laboratory tests: blood test according to the dementia protocol
• Alzheimer's fluid-based biomarker test: blood amyloid/tau determination
• Detailed cognitive assessment: neuropsychological examinations according to dementia protocol
• CogniTeamTM consultation: risk assessment, evaluation, summary discussion

What kind of examinations are taking place, and why are they?

Review the ophthalmological examination

The role of ophthalmological examination in the examination of dementia is receiving increasing attention, as the eye — especially the retina and optic nerve — is a "window" to the brain through which early signs of certain central nervous system dysfunctions can be recognised. Although it is not a primary diagnostic method, an ophthalmological examination can provide valuable additional information, especially in the field of early detection, risk assessment, differential diagnosis, and the detection of certain neurological changes.

The main goals of the ophthalmological examination when examining dementia:

Detection of vision problems, recognition of fundus lesions

• Patients with cognitive decline are often unable to accurately articulate their vision complaints.
  
  
• Visual impairment can be caused by:
  
  
  • Ophthalmic cause (e.g. cataracts, macular degeneration)
    
    
  • Neurological cause (e.g., visual field loss, visual agnosia)
    
    
• An ophthalmological examination can help to isolate them.
  

Review the audiological examination

The role of audiological examination (hearing test) in the examination of dementia is becoming increasingly important, as research in recent years has clearly shown that hearing loss is one of the most significant risk factors for dementia that can be influenced. Hearing loss can lead to social isolation, which is a serious dementia risk factor in itself.

Why is it important to have a hearing test if dementia is suspected?

1. Hearing loss is linked to cognitive decline

• Severe hearing loss that begins in middle-aged patients increases the risk of dementia by up to 5 times.
• The symptoms of dementia can be misinterpreted in the case of hearing loss:g. the patient does not answer questions, has difficulty following conversation, so they may appear to be inattentive or confused, or misunderstand instructions, which may appear to be a memory disorder.
• Thus, in the case of a hearing problem, the suspicion of dementia may arise erroneously or the existing cognitive impairment may appear more serious.

2. Hearing enhancement (e.g. hearing aids) can slow cognitive decline

• Clinical studies show that hearing aids or cochlear implants can improve attention, memory, speech comprehension and reduce the risk of dementia, especially when intervened early.
  
  
• Therefore, it is important that the hearing of patients with dementia or cognitive decline is also screened and treated if necessary.

What does the audiological examination include?

• History: hearing complaints, ear diseases, noise exposure
  
  
• Audiometry: Clear Sound Threshold Test – Determination of Hearing Threshold by Frequency
  

Laboratory tests

Blood laboratory tests play a key role in the investigation of dementia, primarily to rule out reversible causes and to identify comorbidities. Although they do not diagnose dementia on their own, they are essential for a comprehensive examination.

The main goals of blood laboratory tests in dementia are to rule out reversible causes.

• Certain metabolic disorders (blood sugar, liver and kidney dysfunction, etc.), ion balance disorders or deficiencies (e.g. vitamin deficiency, lack of thyroid hormones) can cause cognitive decline, but can be treated if they are detected in time. It is important to detect various inflammatory and infectious conditions. Treating them can slow the progression of cognitive decline.

Diagnosis of a liquid-based biomarker of Alzheimer's disease

Blood amyloid and tau testing (e.g., plasma Aβ42/Aβ40 ratio; determination of amyloid oligomerisation profile, determination of abnormal tau protein concentration in the blood) is a novel, promising biomarker-based method for the investigation of dementia, especially Alzheimer's disease. Although it is not yet a routine test everywhere, its role is becoming increasingly important as it is non-invasive and can indicate the presence of Alzheimer's disease at an early stage. In the near future, it is expected that blood-based detection will become available for more and more diseases that cause dementia.

What is the role of abnormal proteins in Alzheimer's disease?

• The two main neuropathological features of Alzheimer's disease are plaques consisting of beta-amyloid (Aβ) proteins that accumulate in the brain and filaments made up of tau proteins.
• A decrease in the Aβ42/Aβ40 ratio in the blood may indicate the presence of Alzheimer's disease, as the more toxic Aβ42 is more deposited in the brain and remains less in the circulation. Abnormal tau proteins in the blood can also predict Alzheimer's disease.

What is the role of blood Alzheimer's biomarker testing?

1. Early detection

• Changes in amyloid and tau in the blood can be detected years before the onset of symptoms, so they are also suitable for screening for preclinical Alzheimer's disease.
• The biomarker test helps to confirm the diagnosis, especially if the patient's symptoms are still mild and the suspicion of Alzheimer's disease is uncertain.
  
• Biomarker testing can be combined with other tests (e.g., MRI, neuropsychology, APOE genotyping) to increase the accuracy of diagnosis.
  

Detailed cognitive assessment

Neuropsychological examination is one of the most important pillars of dementia examination, as it objectively measures cognitive function and helps to distinguish between different types of dementia and to distinguish dementia from other diseases (e.g. depression, anxiety, mild cognitive impairment – MCI).

What is a neuropsychological examination?

A neuropsychological examination is a structured series of tests that evaluate different cognitive functions, such as:

• Memory (short and long-term)
  
  
• Attention and concentration
  
  
• Executive functions (planning, decision-making, problem-solving)
  
  
• Language skills (speaking, comprehension, vocabulary)
  
  
• Visual-spatial functions (spatial orientation, shape recognition)
  
  
• Abstract thinking
  
  
• Social and emotional functions (to some extent)
  

The examination is performed by a trained neuropsychologist, and the results are evaluated in relation to the person's age, education and other living conditions.

The role of neuropsychological examination in dementia:

1. Objective measurement of cognitive decline

• It helps to determine whether the patient's cognitive complaints (e.g. forgetfulness) are indeed due to a decrease in neurological function or other factors (e.g. depression, stress).
  
• It can distinguish healthy ageing from mild cognitive impairment and dementia.
• The test battery can be individualised according to the clinical issue.

2. Differentiation of the type of dementia

Different types of dementia are associated with a characteristic cognitive pattern:

• Alzheimer's disease: mainly memory impairment, difficulty learning new information
  
  
• Frontotemporal dementia: speech disorder, personality change, behavioral disorder
  
  
• Lewy body dementia: intermittent attention deficit disorder, visual hallucinations, Parkinson's symptoms
  
  
• Vascular dementia: attention, executive functions and motor coordination are primarily affected

3. Tracking cognitive status over time

• Neuropsychological tests can be used to monitor the rate of cognitive decline, which is important for judging the effectiveness of treatment and planning care.

4. Clarification of diagnostic uncertainty

• If the clinical picture is not clear (e.g. there is a complaint, but the neurological and imaging examination is negative), the neuropsychological examination can provide an objective clue.

5. Legal and social aspects

• The results of the examination can help in the assessment of guardianship procedures, driving aptitude and ability to work

Who do we recommend it to?

The Diagnostic Package is primarily recommended for those who have cognitive complaints and would like to have them examined. The use of the package is always introduced by the Screening Package; however, we do not always recommend the use of the Diagnostic Package after the Filter Package (see Filter Package). We will prepare an individual proposal on the application of the package, following the consultation on the Screening Package.

What can happen after the test?

The primary purpose of the package is to isolate what disease may be behind cognitive decline. If a neurocognitive disease is confirmed, its differential diagnosis may also be necessary. If your tests do not reveal any neurological and/or dementia-causing disease, we will recommend a repeat screening according to your age (e.g. over the age of 65, we recommend repeating the screening every 3 years). If we identify a psychiatric, internal medicine, somnology, ophthalmology, otolaryngology, neurological or neurosurgical disease, we recommend a specialist consultation, which we are happy to help you arrange. If a disease causing dementia or an increased suspicion of it is confirmed, in certain cases, we recommend the use of the Differential Diagnostic Services and/or the Genetic Diagnostics Package on an individual basis. If no further tests are necessary for an accurate diagnosis, we recommend using the Intervention Services.

How much does the package cost?

Gross 365.000 Ft.

How to arrive for the examination, and what is the procedure of the examination?

You will receive an appointment for the examination after the CogniTeamTM consultation as part of the Screening Package. The tests begin in the morning with a blood sample (see Blood tests). It is not necessary to come to the blood test on an empty stomach. Due to the long examination time, we specifically ask you to eat and drink before the tests. It is possible to come to the examination with a close relative. After the blood test, the various tests take about 2 hours. The results are evaluated as a team-based decision at a weekly joint CogniTeamTM meeting of its senior experts. The evaluation takes about 2-3 weeks, and you will receive an electronic notification when they are ready. You will then have the opportunity to consult your results and next steps with one of the clinic's leading specialists, a member of CogniTeam TM, in person or online as part of the package.

In addition, we offer the opportunity to participate in clinical drug trials specific to the given disease, if such a study takes place during the given period.

Brain Health Service Genetic Diagnostic Package

What does the Genetic Diagnostic Package contain?

• Detection of genetic dementia diseases, risk profile determination
• Remote consultation on genetic testing – before and after the test
• Sample transport

What kind of examinations are taking place, and why are they?

In our genetic package, we examine a panel of 18 elements. You will receive accurate information about genetic tests in the framework of a genetic consultation prior to the test.

All of the genes studied are associated with the development of dementia in some way, especially Alzheimer's disease, frontotemporal dementia (FTD), dementia associated with Parkinson's disease, and other rarer hereditary neurodegenerative diseases.

The following table overview will help you navigate the importance of genes and the mechanisms they influence:

Who do we recommend it to?

Early-onset dementia

• If symptoms appear before the age of 65, especially under the age of 50, there is a higher likelihood of having a monogenic hereditary genetic form.

Family accumulation

• If several first-degree relatives (parents, siblings, grandparents) have suffered from dementia, especially in a similar type and at a young age, a hereditary form can be suspected.

Suspicion of specific clinical signs or rare syndromes

• If the patient suffers from frontotemporal dementia with behavioral changes or repeatedly suffers a stroke, genetic testing is recommended. Similarly, in the case of rapidly progressive dementia or dementia associated with Parkinson's disease symptoms at a young age, the genetic background must be ruled out.

For legal, family planning, or predictive reasons

In asymptomatic individuals with a known family history of a pathogenic mutation, a predictive genetic test is possible, but only after genetic counselling and following a strict ethical protocol.

• Important: predictive testing also requires psychological support!
  

When is it not recommended?

• In the case of sporadic Alzheimer's disease in old age (>70 years), if there is no family history.
  
  
• When the genetic result would not affect the diagnosis or treatment.
  

What can happen after the test?

The primary goal of the test is to detect cognitive impairment of genetic origin. In all cases, the examination can take place after using the Screening Package and/or the Diagnostic Package. If your examinations do not reveal a suspicion of a neurological and/or dementia-causing disease, we will recommend further neurological examinations according to your age. If a disease causing dementia is confirmed, we recommend the use of Differential Diagnostic Services in certain cases, on an individual basis. If no further tests are necessary for an accurate diagnosis, we recommend using our Intervention Services. In addition, we offer the opportunity to participate in clinical drug trials specific to the given disease, if such a study takes place during the given period.

How much does the package cost?

Gross 1.875.000 Ft.

How to arrive for the examination, and what is the approach of the examination?

You will receive an appointment for the examination after a CogniTeamTM consultation as part of the Screening Package, Diagnostic Package or Differential Diagnostic Services. If you consider it, you can apply for the test independently of using any other package. The examination takes place in the morning hours and involves a blood test. It is not necessary to come to the blood test on an empty stomach; we specifically ask you to eat and drink before it. It is possible to come to the examination with a close relative. The use of the test is always preceded by a preliminary online genetic consultation under the guidance of a human geneticist. After using the package, you have the opportunity to consult in person and online about the results and further steps with one of our leading CogniTeamTM experts, with the involvement of a human geneticist. Within this framework, interpret the results obtained (e.g. pathogenic mutation, probably pathogenic, benign variation). Depending on the final results, we make recommendations for follow-up, therapy, and examination of family members.

Brain Health Differential Diagnostic Services

What tests are available?

Cranial MRI scan

Neuropsychological examination

Determination of amyloid and tau protein in cerebrospinal fluid (liquor)

Routine EEG examination

Sleep EEG examination

Autonomic nervous system examination

EMG-ENG examination on 4 limbs

FDG-PET examination + consultation

Cerebral Perfusion SPECT

DaTSCAN

CogniTeam consultation: risk assessment, evaluation, summary discussion

What kind of examinations are taking place and why are they?

Cranial MRI scan

Cranial MRI (magnetic resonance imaging) is an important tool in the examination and screening of dementia because it provides a detailed picture of the structure of the brain and allows the doctor to identify changes that may be related to cognitive decline. The test is performed according to a special protocol that includes T1, T2, FLAIR, SWI and diffusion sequences, as well as visual scoring (e.g. Koedam scale, Scheltens scale) and AI-assisted volumetric analysis (e.g. hippocampal volumetrics).

The role of cranial MRI in dementia:

1. Detection of cerebral atrophy (atrophy)

• MRI is able to show atrophy of brain tissue, in particular:
  
  
  • In Alzheimer's disease, atrophy of the hippocampus and medial temporal lobe is characteristic.
    
    
  • In frontotemporal dementia, asymmetric atrophy of the frontal and temporal lobes is observed.
    
    
• The pattern of atrophy can help differentiate between the types of dementia.

2. Recognition of vascular lesions

• MRI sensitively indicates small vessel disease, white matter lesions and signs of stroke.
  
  
• These changes may indicate vascular dementia or mixed types of dementia (e.g., Alzheimer's and vascular components together).

3. Exclusion of other diseases

MRI helps rule out brain diseases that can cause cognitive impairment, such as:

• Brain tumors
  
  
• Normal-pressure hydrocephalus (NPH) – typically enlarged cerebral ventricles with normal-pressure cerebrospinal fluid.
  
  
• Chronic hematoma (subdural hematoma)
  
  
• Inflammatory or infectious neurological disorders

4. Confirm and follow up on the diagnosis

• MRI contributes to early diagnosis, especially in atypical cases of dementia.
  

Follow-up MRI scans can be used to monitor the progression of the disease.

Neuropsychological examination

A neuropsychological examination is a structured series of tests that evaluate different cognitive functions, such as:

• Memory (short and long-term)
  
  
• Attention and concentration
  
  
• Executive functions (planning, decision-making, problem-solving)
  
  
• Language skills (speaking, comprehension, vocabulary)
  
  
• Visual-spatial functions (spatial orientation, shape recognition)
  
  
• Abstract thinking
  
  
• Social and emotional functions (to some extent)
  

The examination is performed by a trained neuropsychologist, and the results are evaluated in relation to the person's age, education and other living conditions.

The role of neuropsychological examination in dementia:

1. Objective measurement of cognitive decline

• It helps to determine whether the patient's cognitive complaints (e.g. forgetfulness) are indeed due to a decrease in neurological function or other factors (e.g. depression, stress).
  
• It can distinguish healthy ageing from mild cognitive impairment and dementia.
• The test battery can be customised.

2. Differentiation of the type of dementia

Different types of dementia are associated with a characteristic cognitive pattern:

• Alzheimer's disease: mainly memory impairment, difficulty learning new information
  
  
• Frontotemporal dementia: speech disorder, personality change, behavioral disorder
  
  
• Lewy body dementia: intermittent attention deficit disorder, visual hallucinations, Parkinson's symptoms
  
  
• Vascular dementia: attention, executive functions and motor coordination are primarily affected

3. Tracking cognitive status over time

• Neuropsychological tests can be used to monitor the rate of cognitive decline, which is important for judging the effectiveness of treatment and planning care.

4. Clarification of diagnostic uncertainty

• If the clinical picture is not clear (e.g. there is a complaint, but the neurological and imaging examination is negative), the neuropsychological examination can provide an objective clue.

5. Legal and social aspects

• The results of the examination can help in the assessment of guardianship procedures, driving aptitude and work ability.
  

Liquor amyloid and tau determination

Analysis of the amyloid and tau proteins of cerebrospinal fluid (cerebrospinal fluid, cerebrospinal fluid – CSF) is among the most reliable biomarker-based methods for the early detection of Alzheimer's disease and other neurodegenerative dementias. These tests help confirm the biological diagnosis of Alzheimer's disease, even before clinical symptoms appear.

What does the CSF biomarker test measure?

The most commonly studied Alzheimer s-specific biomarkers are:

What is the role of the test in the examination of dementia?

1. Early diagnosis

• Biological signs of Alzheimer's disease (decreased Aβ42, elevated tau) appear years before clinical signs.
  
  
• It can help distinguish it from healthy aging or other types of dementia.

2. Diagnostic confirmation in atypical cases

• If the clinical picture is unclear, CSF biomarkers can confirm or rule out Alzheimer's disease, such as:

3. Differential diagnosis

• Cerebrospinal fluid biomarkers help to distinguish:
  
  
  • Alzheimer's disease from other neurodegenerative dementias
  • From inflammatory, infectious, or autoimmune diseases

4. Biomarker profiling for research purposes

• CSF biomarkers are standard elements of clinical research on Alzheimer's disease.
  
  
• They can also be used to monitor the patient's therapeutic response in the future.
  

Routine EEG examination

Routine EEG (electroencephalography) testing is not the primary diagnostic tool in the examination of dementia, but in some cases it can be a useful adjunctive test, especially for differential diagnostic purposes or in atypical cases.

What is EEG?

An EEG records the electrical activity of the brain using electrodes placed on the scalp. It is primarily used to examine epilepsy, disorders of consciousness and encephalopathies.

The role of EEG in the examination of dementia:

1. In case of rapid progression or atypical course, EEG is recommended.

2. In case of suspected epilepsy

• In Alzheimer's disease and other dementias, the frequency of epileptic seizures increases.
  
  
• EEG can help detect epileptic seizures and epilepsy-related disorders of consciousness.

3. EEG may also play a role in distinguishing delirium and dementia.

4. In the case of toxic-metabolic encephalopathies, EEG examination is a useful differential diagnostic method.

Sleep EEG examination

The role of sleep EEG in the examination of dementia is not routine, but it can be a useful additional test in certain special cases, especially if sleep disorders or suspected epilepsy arise in the background of the patient's symptoms. In addition, its role in the early detection of Alzheimer's disease and other neurodegenerative diseases is becoming increasingly important in research.

What is sleep EEG?

During a sleep EEG, the patient's electrical activity in the brain during sleep is examined, either in the form of a nighttime total sleep test (polysomnography) or an EEG performed after sleep deprivation. It can record sleep phases, epileptiform activity, and sleep-dependent breathing and behavioural disorders.

• Sleep EEG can help detect sleep-dependent epileptic activity common in Alzheimer's disease, as well as detect sleep-wake cycle disorders (e.g. REM behavioural disorder, insomnia, daytime sleepiness) that are often associated with dementia.
  

Examination of the autonomic nervous system

The study of the functioning of the autonomic nervous system is important in the examination of dementia, especially in neurological differential diagnosis and in the more accurate determination of the type of disease.

Why is it important to examine autonomic function in dementia?

• Some dementias (e.g. Lewy body dementia) are characterised by autonomic dysfunction (e.g. orthostatic hypotension, bladder dysfunction). Early detection of autonomic disorders provides an opportunity for symptomatic treatment, which improves quality of life

EMG-ENG examination on 4 limbs

The role of EMG (electromyography) and ENG (electroneurography) examinations in the examination of dementia is limited and complementary, as these examinations primarily assess the functioning of the peripheral nervous system (nerves and muscles), while dementia is mainly associated with central nervous system (brain) diseases.

What is EMG and ENG?

• EMG: examination of the electrical activity of the muscles. It helps to detect and isolate muscle or nerve damage.
  
  
• ENG: examination of the functioning of peripheral nerves.

Possible role of EMG-ENG tests in the examination of dementia:

1. Differential diagnostics

• If the patient's symptoms include peripheral neuropathy (e.g. muscle weakness, numbness, sensory disturbance), EMG-ENG can help determine whether the symptoms are caused by peripheral neuropathy, radiculopathy or another neuromuscular disease.
  
  
• In some neurodegenerative diseases (e.g. amyotrophic lateral sclerosis - ALS), dysfunction of central and peripheral motor neurons may also appear, in the detection of which EMG is important.

2. Differentiation of neuromuscular diseases associated with muscle weakness

• If dementia is accompanied by muscle weakness or muscle pain, EMG can help to detect e.g. myopathies or neuromuscular diseases (e.g. myasthenia gravis).

FDG-PET test

FDG-PET (fluoro-deoxyglucose positron emission tomography) examination plays a significant role in the examination of dementia, especially in the clarification of diagnosis and the differentiation of dementia types.

What is FDG-PET?

FDG-PET is a radioisotope test that measures sugar metabolism in the brain. It can be used to map the metabolic activity of the brain, which shows different patterns in different diseases. FDG-PET is suitable for the early detection of brain function decline before structural imaging (MRI) abnormalities appear. The procedure can be used to monitor disease progression and monitor therapeutic response in research or specific clinical situations.

Cerebral perfusion SPECT examination

The role of SPECT (Single Photon Emission Computed Tomography) in the examination of dementia is to indirectly assess cerebral blood flow (perfusion) and metabolism, which can help to differentiate between types of dementia and to clarify the diagnosis.

What is SPECT?

SPECT is a procedure using radioactive isotopes (e.g. technetium-99m labelled molecules) to map blood flow to the brain. The pattern of reduced blood flow can be indicative of certain neurodegenerative diseases, which helps to differentiate between different types of dementia.

DAT-Scan Scan

DAT-Scan (Dopamine transporter scintigraphy) is a special test in which the state of the brain's dopaminergic nerve pathways is examined with a radiolabeled molecule (e.g. I-123 ioflupane). It plays an important role in distinguishing certain types of dementia (e.g. Lewy body dementia, Parkinson's dementia).

Who do we recommend it to?

For those who have a disease causing dementia or increased suspicion of it after using the Diagnostic Package and/or the Genetic Diagnostic Package.

For those who have been diagnosed with dementia or mild cognitive impairment, and would like to receive recommendations for their diagnosis and therapy.

What can happen after the test?

The evaluation of the results obtained takes about 2-3 weeks, based on which the diagnostic and therapeutic recommendation is made as a joint decision of the leading experts of the service (so-called CogniTeamTM). The use of the Differential Diagnostic Services is followed by a personal or online consultation with one of the leading specialists of the service. If no further tests are necessary for an accurate diagnosis, we recommend using our Intervention Services. The examinations can reveal other neurological diseases, in which case we recommend a neurological consultation, which we are happy to help you arrange. In addition, we offer the opportunity to participate in clinical drug trials specific to the given disease, if such a trial is ongoing in the given period.

How much do the services cost?

• Cranial MRI scan: 75.000 HUF gross
• Neuropsychological examination: 90.000 HUF gross
• Brainwater (liquor) amyloid and tau protein determination: 50.000 HUF gross
• Routine EEG examination: 40.000 HUF gross
• Sleep EEG test: 60.000 HUF gross
• Examination of the autonomic nervous system: 50.000 HUF gross
• EMG-ENG examination on 4 limbs: 50.000 HUF gross
• FDG-PET examination + consultation (on site): Gross 300.000 HUF + 20.000 HUF
• Cerebral perfusion SPECT (at external location): 60.000 HUF gross
• DaTSCAN (externally): 600.000 HUF gross
• CogniTeamTM consultation: risk assessment, evaluation, summary meeting: HUF 80,000 gross