Memory loss/cognitive impairment

Question 1

What aspects of cognition need to be covered in the history of a patient presenting with suspected cognitive impairment? (7)

Answer 1

Orientation (time place and person)
Short and long-term memory
Psychiatric features e.g. mood, anxiety
Personality changes
Praxis
Attention/concentration
Screen for organic causes

Question 2

Formal screen for cognitive impairment?

Answer 2

Mini Mental State examination (MMSE)

Question 3

What investigations should be ordered to ensure that no reversible causes have been missed out?

Answer 3

FBC, B12 and folate
Thyroid function
Glucose
LFT
Infection screen- MSU, CXR

Question 4

Investigation to determine subtype

Answer 4

SPECT can distinguish between Alzheimer’s, vascular, FTD

Question 5

Important patient safety aspects in consultation?

Answer 5

Home support e.g. if they live by themselves, are they at risk of leaving the oven on
DVLA- need to be informed of any diagnosis

Question 6

Pharmacological management of Alzheimer’s Disease

Answer 6

Acetylcholinesterase inhibitors e.g. donepezil

NMDA antagonist e.g. memantine

Question 7

In order to have capacity to make a medical decision, what must the patient have?

Answer 7

Ability to understand, retain and utilise information as part of a decision making process; communicate their decision by any means