Dementia Evaluation and Workup

Dementia Evaluation and Workup

INITIAL EVALUATION: Should almost always be in outpatient setting where can assess over time without acute illness or delirium

 • Obtain collateral (family member or friend), ADLs/IADLs, assess safety, screen for depression

 • Review medications for those with cognitive s/e’s (e.g., analgesics, anticholinergics, psychotropic medications, sedative-hypnotics)

 • Assess cognitive impairment (MOCA >> MMSE), track score at subsequent visits

 • Labs: CBC, TSH, BMP; consider: RPR, Lyme, HIV, UA, hvy metals, ESR, LFT, folic acid, B1, B6, B12 

 • Neuroimaging: NCHCT or MRI brain (preferred) to r/o structural lesion (tumor), assess atrophy pattern, eval for vascular dementia and microhemorrhages (CAA). PET can be considered if dx unclear but often unnecessary.

 • Formal neuropsych testing: pattern of deficits can suggest particular dementia syndrome; also helpful to r/o comorbid psych dz

 • Inpatient evaluation is almost never appropriate, but should be considered for any rapidly progressing dementia syndrome or a new dementia diagnosis in pts <55 (consult Neuro for ?LP, consider RT-QuIC >14-3-3 [CJD], ACE [sarcoid], AI encephalitis, paraneoplastic encephalitis [only after d/w Neuro]), new focal neurologic deficits (?stroke), fall with head trauma or LOC

 • Outpatient Neurology referral to Memory/Cognitive clinic

#Dementia #Evaluation #Workup #diagnosis 
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