Case Files Family Medicine by Eugene Toy & Donald Briscose & Bruce Britton

Author:Eugene Toy & Donald, Briscose & Bruce, Britton
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2012-09-14T16:00:00+00:00

APPROACH TO:

Dementia

DEFINITION

EXECUTIVE FUNCTIONS: High-level cognitive abilities that control other, more basic, abilities. Executive functions include the ability to start and stop behaviors, alter behaviors to fit circumstances, and adapt behaviors to new situations.

CLINICAL APPROACH

The essential features of the diagnosis of dementia are a memory loss and impairment of executive function. Dementia is a clinical diagnosis that can go unrecognized until it is in an advanced stage. Patients rarely report memory loss; the informants are usually their family members. However, relatives may fail to recognize signs and symptoms of dementia because many have a tendency to think that memory loss can be a part of normal aging. Studies of aging have showed that nonverbal creative thinking and new problem-solving strategies may decline with age, but information, skills learned with experience, and memory retention remain intact.

Clinicians should assess cognitive function whenever cognitive impairment or deterioration is suspected. These concerns may be based upon direct observation, patient report, or concerns raised by family members, friends, or caretakers. Patients with dementia may have difficulty with one or more of the following:

• Learning and retaining new information (rely on lists, calendars)

• Handling complex tasks (banking, bills, payments)

• Reasoning (adapting to unexpected situations, unfamiliar environment)

• Spatial ability and orientation (getting lost driving, walking)

• Language (word finding, repetition, confabulation)

• Behavior (agitation, confusion, paranoia)

The evaluation of a patient with suspected dementia should include a mental status examination. The Folstein Mini-Mental Status Examination (MMSE) is the most widely used tool in the screening for dementia. The sensitivity of the MMSE for dementia is as high as 87% and the specificity is as high as 82%. The interpretation of the score depends on the patient’s education level. It is most accurate in those with at least a high school education.

Another valuable test that can be used in a busy primary care setting is the Clock Test. The patient is asked to draw a clock with a specific time. The patient must then accurately draw the clock face with the “big hand” and “small hand” in the correct positions. It is quick, easy to administer, and evaluates executive function in multiple cognitive domains. Other brief cognitive screening tests, such as the Short Portable Mental Status Questionnaire, modified MMSE, and Mini-Cog (three-item recall combined with clock drawing) can be used in the primary care setting.

In the evaluation of dementia, it is necessary to get information from people who know the patient well. Useful information can be obtained from informant-based functional tests, such as the functional activities questionnaire (FAQ), the instrumental activities of daily living (IADL), and caregiver burden assessments. This information can be important for physicians and families in making plans for long-term care.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.