Cognitive impairment is not always associated with dementia. For this reason, a full comprehensive history is an integral component of any cognitive assessment. Presenting complaints of memory loss or changes in behavior, demeanor, or activity in the elderly population may be reflective of a psychiatric illness including a mood or anxiety disorder, a response to a new medication or a change of dosing, or an underlying medical condition. In some cases, what may appear to be a cognitive impairment may actually be an underlying depression or anxiety disorder in which attention and concentration become difficult.
A picture of the patient’s functional capacity should be obtained, including ability to perform basic activities of daily living (washing, dressing, grooming) and instrumental activities of daily living including managing finances, shopping, transportation, telephone use, and medication management. Cognitive reserve factors should be well understood including the patient’s level of education, engagement in social and physical activities, and background of performing complex mental tasks.
The remainder of the assessment should focus on gathering a medical history, family history, substance use history, and medication review. Laboratory tests such as a complete blood cell count, electrolyte panel, renal and liver function tests, thyroid function, and serum vitamin B12 levels should be done to rule out any reversible causes of cognitive impairment.
For more on this topic, see Tools and Tips for Assessing Cognition in Older Adults: Issues for Psychiatrists, on which this quiz is based.