- Last edited on October 3, 2022
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geri:dementia:home [on October 3, 2022] psychdb [Approach to Dementia] |
geri:dementia:home [on October 3, 2022] psychdb [Approach to Dementia] |
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| - **Rule out [[mood:1-depression:home|depression]]** ("pseudodementia"). Consider atypical presentations: anxiety, irritability, unexplained physical complaints, worsening cognition. Once the depression is treated, the dementia symptoms go away! | - **Rule out [[mood:1-depression:home|depression]]** ("pseudodementia"). Consider atypical presentations: anxiety, irritability, unexplained physical complaints, worsening cognition. Once the depression is treated, the dementia symptoms go away! | ||
| - **Rule out any [[addictions:home|substance use disorders]]** | - **Rule out any [[addictions:home|substance use disorders]]** | ||
| - | - **Rule out any reversible causes** | + | - **Rule out any reversible causes, by ordering investigations such as:** |
| - | * Order bloodwork: | + | * **CBC** (to rule out anaemia and some cancers that can may present with fatigue, weight loss, and other depressive symptoms) |
| - | * CBC (to rule out anaemia and some cancers that can may present with fatigue, weight loss, and other depressive symptoms) | + | * **TSH** (to rule out [[cl:thyroid-disorders:hypothyroidism|hypothyroidism]] that can cause a depressive syndrome) |
| - | * TSH (to rule out [[cl:thyroid-disorders:hypothyroidism|hypothyroidism]] that can cause a depressive syndrome) | + | * **Creatinine** (to rule out renal disease that can present with fatigue, weight loss, poor concentration, and other depressive symptoms, and to assess for overall renal function) |
| - | * Creatinine (to rule out renal disease that can present with fatigue, weight loss, poor concentration, and other depressive symptoms, and to assess for overall renal function) | + | * **Electrolytes** |
| - | * Electrolytes | + | * Sodium, in particular for hyponatremia (which can present with fatigue, poor concentration, and other depressive symptoms) |
| - | * Sodium, in particular for hyponatremia (which can present with fatigue, poor concentration, and other depressive symptoms) | + | |
| * Calcium ([[cl:hypercalcemia-hyperparathyroidism|hypercalcemia]] may result in neuropsychiatric symptoms including psychosis and depression) | * Calcium ([[cl:hypercalcemia-hyperparathyroidism|hypercalcemia]] may result in neuropsychiatric symptoms including psychosis and depression) | ||
| - | * Parathyroid hormone (PTH) and vitamin D (because increased PTH and decreased vitamin D may be associated with depressive symptoms) | + | * **Parathyroid hormone (PTH)** and **vitamin D** (because increased PTH and decreased vitamin D may be associated with depressive symptoms) |
| - | * Glucose (to rule out diabetes that can present with fatigue, weight loss, and other depressive symptoms) | + | * **Glucose** (to rule out diabetes that can present with fatigue, weight loss, and other depressive symptoms) |
| - | * Ferritin/iron | + | * **Ferritin/iron** (for fatigue and cognitive impairment) |
| - | * [[cl:vitamin-b12-cyanocobalamin-deficiency|Vitamin B12]] (to rule out low B12 that can cause a depressive syndrome) | + | * [[cl:vitamin-b12-cyanocobalamin-deficiency|Vitamin B12]] (to rule out low B12 that can cause a depressive syndrome) |
| - | * Folate level (to rule out low folates that can cause a depressive syndrome) | + | * **Folate level** (to rule out low folates that can cause a depressive syndrome) |
| - | * Consider neuroimaging such as [[neurology:ct-scan|CT]] or [[neurology:mri|MRI]] | + | * **Neuroimaging** such as [[neurology:ct-scan|CT]] or [[neurology:mri|MRI]] |
| - | * VDRL (screening for [[cl:neurosyphilis|syphillis]]) | + | * **VDRL** (screening for [[cl:neurosyphilis|syphillis]]) |
| - | * [[cl:hiv|HIV]] (for HIV-associated neuropsychiatric presentations or HIV-associated cognitive impairment) | + | * **[[cl:hiv|HIV]]** (for HIV-associated neuropsychiatric presentations or HIV-associated cognitive impairment) |
| - | * Serum albumin (to assess nutritional status and rule out diseases that can present with depressive symptoms) | + | * **Serum albumin** (to assess nutritional status and rule out diseases that can present with depressive symptoms) |
| + | - **Medication Review** | ||
| * Medication-induced "dementia" | * Medication-induced "dementia" | ||
| - | * Is there polypharmacy that could be contributing to the cognitive impairment? | + | * Is there polypharmacy that could be contributing to the cognitive impairment? |
| - | * Is there the use of any anticholinergic medications (and [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic toxicity]]?) | + | * Is there the use of any anticholinergic medications (and [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic toxicity]]?) |
| - | * Is there the use of other medications that could cause cognitive issues? | + | * Is there the use of other medications that could cause cognitive issues? |
| - | * e.g. - steroid dementia syndrome related to glucocorticoid use. | + | * e.g. - steroid dementia syndrome related to glucocorticoid use. |
| + | - **Neurological Review** | ||
| + | * Do a [[neurology:neuro-exam:home|neurological exam]] if appropriate | ||
| * Consider other neurological disorders including [[neurology:approach-normal-pressure-hydrocephalus-nph|normal pressure hydrocephalus]] | * Consider other neurological disorders including [[neurology:approach-normal-pressure-hydrocephalus-nph|normal pressure hydrocephalus]] | ||
| - **Is it dementia, mild cognitive impairment (MCI), or normal aging?** | - **Is it dementia, mild cognitive impairment (MCI), or normal aging?** | ||