Topic Info - BotMed Application

TopicName

Confusion causes (chronic, dementia)

ClinicalTests

CBC with dif (anemia, dehydration);
GGT (alcoholism);
BNP (CHF);
vitamin D, B12, folate, homocysteine in blood;
Electrolytes, BUN/creatinine (KI function);
Blood sugar (hypoglycemia);
Troponin - CK-MP (MI);
UA toxins (substance abuse);
VDRL/RPR (syphilis);
CD4 (HIV);
Serum calcium, serum glucose;
TSH (Hypothyroidism);

ImagingStudies

CT of the head;
Dopier US of carotid artery;
ECG;

PhysicalExams

Vital signs; complete neurologic exam, including mini-mental status exam and gait; general physical exam, including ENT, heart, lungs, abdomen, and extremities.

Comment

Brain structure/trauma; anemia; hormones; infection; GU; vascular; cardio; psycho; substances/food!
Always include delirium and dementia for older patients;
Must include history from family members/caregivers when available. Detailed time course of cognitive deficits (acute vs. chronic/gradual onset); associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression); screen for delirium (waxing/waning level of alertness); falls, medications (and recent medication changes); history of stroke or other atherosclerotic vascular disease, syphilis, HIV risk factors, alcohol use, or vitamin B12 deficiency; family history of Alzheimer’s disease or other neurologic disorders.

MMSE, MOCA (best screening test), dementia quick screen (see sidebar)

WebLink

https://www.aafp.org/afp/1998/0315/p1358.html