MIAH Toolkit Mini-Tutorial: Page 5


			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.


	Once the evaluation is complete and the test results are in, the first follow-up visit is to communicate the diagnosis and help patients and caregivers with problems.

Mini-Tutorial Step 5: First Follow-up Visit

steps:

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Section Descriptions:

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steps:

1 | 2 | 3 | 4 | 5

Caregiving Issues:
A questionnaire for caregivers to identify potential problems.

This questionnaire collects information on the caregivers ability to provide sustained help and things causing stress. Driving and advance directive questions are also included, as these issues are often in need of early consideration in a progressive cognitive disorder.

Support Documentation:

Family Report: Caregiving Issues (View PDF)

Diagnostic Assessment:
Mrs. Smith shows definite cognitive impairment (Folstein of 21/30, norm 28) and functional impairment (score 11 on functional measure). She meets established criteria for the diagnosis of dementia. The characteristic slow, gradual decline with no alternate explanation from the evaluation makes the probable cause Alzheimer�s disease. The elevated TSH suggests subclinical hypothyroidism, but is not an explanation for cognitive loss. Her depression screen is marginally elevated, but this also is not a likely explanation for her cognitive loss, and more likely a response to the losses. Additional depression evaluation could be considered, as her mood could be improved with treatment.

Recommendations:
The AAN position paper on treatment of Alzheimer�s disease recommends vitamin E at a dose of 1000 IU twice daily and cholinesterace inhibitor treatment. Cholinesterace inhibitors are more often effective at the maximum dose, and treatment should be increased until this is reached.