Cognitive impairment evaluation and management

Abstract

To diagnose and treat a patient presenting with a cognitive complaint, the clinician uses a systematic approach that identifies the presence and severity of the impairment, the cognitive domains involved, the likely underlying causes, and the most appropriate interventions. Although some aspects of the work-up are completed for all patients (eg, selected laboratory tests and imaging), the decision to pursue a more detailed work-up is influenced by the goals of the evaluation. A brief discussion with the patient and family about the goal of the visit provides the necessary information to customize the approach. The decision to refer a patient to a specialist can be considered at the close of the initial assessment. Cases of early-onset, rapidly progressive, or otherwise atypical cognitive impairment (eg, prominent language or social-behavioral symptoms with little or no memory loss) should be referred to a specialist.5–7 Other factors that might influence a decision to refer include provider experience, clinic resources, patient preference, and availability of specialty centers.2 One particularly compelling reason to refer to an academic center is interest in participation in clinical research.