What are the next steps when a screening tool suggest cognitive impairment is present?

Updated: Dec 02, 2020
  • Author: Claudia L Reardon, MD; more...
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Answer

If clinical history and a cognitive screen suggest cognitive impairment, then further diagnostic assessment and testing is often performed. The following assessments help to rule out treatable causes of cognitive impairment and to delineate exact causes of dementia:

  • Drug history, including substances of abuse as well as medications (especially analgesics, anticholinergics, and sedative-hypnotics). [19]

  • A thorough physical examination, including a neurological examination.

  • Laboratory testing. The American Academy of Neurology recommends screening for B12 deficiency and hypothyroidism in patients diagnosed with dementia. [20] Additionally, clinicians may order laboratory tests to assess complete blood count, electrolytes, glucose, renal and liver function tests, neurosyphilis status, folate, urinalysis, ESR, ANA, CRP, HIV, Lyme, copper, ceruloplasmin, and heavy metal screen. At this time, genetic testing of any sort is not recommended to screen for dementia or for specific causes of it.

  • Other diagnostic tests may be ordered depending on clinical picture: brain MRI, PET, SPECT, lumbar puncture, EEG, and brain biopsy.

  • Neuropsychological testing. A cognitive screen, designed to occur during brief appointments and often in the primary care setting, is not a substitute for a full neuropsychological assessment in uncertain cases. This more thorough evaluation can sometimes help to delineate subtypes of dementia and uses comprehensive screening instruments to examine attention/working memory, new verbal learning and recall, expressive language, visual construction, executive function, and abstract reasoning. [1]

  • Screening for depression, which may masquerade as dementia


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