The initial four tool kits (Memory Loss, Urinary Incontinence, Depression, and Falls) were developed for the Practicing Physician Education in Geriatrics project supported by a grant from the John A. Hartford Foundation through the American Geriatrics Society. The MIAH is providing continued support for the ongoing development of new tool kits. The tool kits are intended to help physicians
better understand the common 'Geriatric Syndromes' and contain educational materials, suggested guidelines, forms and tools
for evaluation, diagnosis and treatment.
The Preliminary Diagnostic Assessment summarizes the findings of the evaluation
and chooses additional investigations to complete the evaluation of the cause. Educational material specific to common
choices for additional evaluation help patients and caregivers participate in decisions.
Lab: The 2001 American Academy of Neurology guidelines for memory loss evaluation recommend only a TSH and a B12
level. Older published recommendations include electrolytes, calcium, a serologic test for syphilis and HIV testing. These
tests may remain useful in selected individuals.
Imaging: The 2001 AAN Guideline suggests one brain imaging procedure as useful in dementia evaluation. A non-contrast
CT is the least expensive test, and is sufficient for excluding the rare treatable conditions such as normal pressure
hydrocephalus, subdural hematoma, brain tumor. An MRI provides additional sensitivity to vascular damage, and can help
diagnose a vascular cause.
Medication Changes: Any drug with the possibility of adverse cognitive effects should be considered for elimination for a
sufficient period to be sure it is not causing cognitive loss.
Referrals: Several categories of specialists can provide additional help in memory loss diagnosis. Neuropsychologists
administer and interpret batteries of cognitive tests.
Neuropsychological evaluation is particularly important when mild
impairment is found on screening measures such as the MMSE, and the primary question is whether or not a cognitive disorder is
Neurologists are experts in the differential diagnosis of neurological disorders, including dementia. When the story
or findings on examination suggest an unusual cause, neurological evaluation may help with diagnosis.
those with geriatric training, can help identify depression and psychosis, and are generally experienced in the management of the
behavioral symptoms that accompany dementia.