MIAH Toolkit Mini-Tutorial: Page 4


			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.

Mini-Tutorial Step 4: Initial Visit Preliminary Diagnostic Assessment

steps:

1 | 2 | 3 | 4 | 5

	View Printable Version (PDF File)
	Download Acrobat Reader
Section Descriptions:

Use our interactive form to view detailed section descriptions by following these simple steps. 1. Roll your mouse over the white sections in the form. 2. When the area highlights to blue this indicates that the section is active. 3. Click on the active section highlighted in blue to view a detailed description. 4. Roll over other white sections and click to view more detailed descriptions. note: only white sections have detailed descriptions.

steps:

1 | 2 | 3 | 4 | 5

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 present.

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.

Psychiatrists, particularly those with geriatric training, can help identify depression and psychosis, and are generally experienced in the management of the behavioral symptoms that accompany dementia.