Spotting the Zebra: Keeping an Open Mind When Evaluating Cognitive Impairment

What is the difference between errors and discrepancies in radiological interpretations? How often do errors occur, and how can they be avoided? Explore these questions in this CME activity from Banner Alzheimer's Institute.

Case Conference 

The Banner Alzheimer’s Institute Case Conference is a weekly event in which physicians and staff discuss challenging and/or teaching cases of patients seen at the Institute’s Stead Family Memory Clinic. These conferences are attended by a multidisciplinary group that includes Banner Alzheimer’s Institute dementia specialists, community physicians (internal medicine, family medicine, and radiology), physician assistants, social workers, nurses, medical students, residents, and fellows. The Banner Alzheimer’s Institute located in Phoenix, Arizona, has an unusually ambitious mission: to end Alzheimer’s disease without losing a generation, set a new standard of care for patients and families, and forge a model of collaboration in biomedical research. The Institute provides high-level care and treatment for patients affected by Alzheimer’s disease, dementia, and related disorders. In addition, the Institute offers extensive support services for families and many unique and rewarding research opportunities.

To cite: Gopalakrishna G, Hendrie KA. Spotting the Zebra: Keeping an Open Mind When Evaluating Cognitive Impairment. Prim Care Companion CNS Disord. 2020;22(5):20alz02812.

To share:

© Copyright 2020 Physicians Postgraduate Press, Inc.

Target Audience

  • Primary care clinicians

Learning Objectives

Use appropriate tools in the differential diagnosis of cognitive impairment

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
Activity expires: 

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. This special series of case reports about dementia was deemed valuable for educational purposes by the Publisher, Editor in Chief, and CME Institute staff. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Use appropriate tools in the differential diagnosis of cognitive impairment

Statement of Need and Purpose

Causes of cognitive impairment can be diagnosed using medical history, cognitive and physical examination, laboratory testing, and brain imaging. Some clinicians are unaware of protocols for neuroimaging referrals. Clinicians need education on the appropriate use of imaging for patients with cognitive impairment.

Release, Review, and Expiration Dates

This brief report activity was published in October 2020 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2022. The latest review of this material was October 2020.

Disclosure of Off-Label Usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this article.



Additional Information

Information about the patient case has been de-identified to protect anonymity.


The opinions expressed are those of the authors, not of Banner Health or Physicians Postgraduate Press.

Faculty Affiliation

Ganesh Gopalakrishna, MD
Banner Alzheimer’s Institute, Phoenix, Arizona

Kyle Angus Hendrie, DO
Banner Alzheimer’s Institute, Phoenix, Arizona


Ganesh Gopalakrishna, MD, is a geriatric psychiatrist and dementia specialist at Banner Alzheimer’s Institute and a clinical associate professor of psychiatry at the University of Arizona College of Medicine, Phoenix, Arizona.

Kyle Angus Hendrie, DO, is a resident physician in the Department of Psychiatry, University of Arizona, Phoenix, Arizona.

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Larry Culpepper, MD, MPH, Editor in Chief of The Primary Care Companion for CNS Disorders, has been a consultant for Acadia, Allergan, Eisai, Merck, Supernus, and Takeda; has been a stock shareholder of M-3 Information; and has received royalties from UpToDate and Oxford University Press. No member of the CME Institute staff reported any relevant personal financial relationships.

Drs Gopalakrishna and Hendrie have no personal affiliations or financial relationships with any commercial interests to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.


Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation


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