Common Psychiatric Histories - Cognitive Impairment Flashcards
Key questions to ask in cognitive impairment
Insidious onset - degenerative process
Subacute - metabolic, neoplastic?
Rapid - acute delirium, vascular event
Memory loss
- forgetting appointments, recent events
- difficulty learning new things
Indecisiveness
Disorientation in time and place
Difficulties with ADLs
Screening for specific types of cognitive impairment
AD
-amnesia, aphasia, apraxia, agnosia
Vascular
- on the background of recent CVA
- stepwise declines in movement and memory
DLB
- Parkinsonism
- fluctuating cognition
- visual hallucinations
FTD
- personality change - withdrawing from others, apathy
- cognition preserved
Past medical history
-key areas to ask about
Any -past head injuries -heart problems, strokes Ask about cardiovascular risk factors -smoking, alcohol, physical activity -HTN, cholesterol, DM
Family history of cognitive impairment - ask about ages
Systemic review
General
- weight loss, night sweats, back pain - malignancy related
- fever - infection, delirium?
- head injury
Psychiatric
- mood screen
- risk screen
Neuro
- seizures, behavioural changes, headaches, visual changes, hearing changes
- changes in movement, sleep, constipation? - PD
Social history
-key questions
Living
- who are you living with
- carers? dependents?
- difficulties with ADLs
Occupation
-work and impacts
Substances
- alcohol dependence - wernickes and korsakoffs?
- smoking
- recdrugs
Travels
-driving? any issues
Investigations to consider
Cognitive test - MMSE
Exclude reversible causes of cognitive decline
FBC, ESR, CRP - infection, inflammation => delirium?
U&E - delirium?
HbA1c, glucose - hyperglycemia
Thyroid function - hypothyroidism
B12, folate - deficiency
Possible differentials
Reversible
- Drugs, delirium
- Emotional - depression
- Metabolic
- Ear, eye impairments
- Nutrition - B12, folate
- Tumour, trauma
- Infection
- Atherosclerotic complications - stroke
Irreversible
- AD, VD, DLB, FTD
- PD
