Dementia Work-Up

Diagnosis

DSM-IV Definition:

• Major impairment in learning and memory plus impairment in handling complex tasks, impairment in reasoning ability, impaired spatial ability and orientation, or impaired language
• Symptoms significantly interfere with work, usual social activities, relationships
• Significant decline from previous level of functioning
• Disturbances are insidious and progressive
• Disturbances are not occurring exclusively during the course of delirium
• Disturbances are not accounted for by major psychiatric diagnosis
• Disturbances are not accounted for by systemic disease or another brain disease

Work-Up

1. Mini-mental status exam
   1. Score less than 24 suggests cognitive impairment
   2. May be influenced by education and age
      1. Score less than 29 if greater than 9 years of schooling suggests cognitive impairment
      2. Score less than 26 if 5-9 years of schooling suggests cognitive impairment
      3. Score less than 22 if less than 4 years of schooling suggests cognitive impairment
2. CBC
3. Chem 10
4. UA/Utox
5. ECG, CXR
6. ETOH
7. CT/MRI
8. Consider
   1. LFTs, TSH
   2. B12, RPR, ESR, ANA, Folate, Thiamine, HIV
   3. neuropsych eval
   4. Consider LP, urine heavy metals, EEG

Treatment

Give MVI, thiamine, folate

Source

7/1/09 PANI (Adapted from Donaldson)