Introduction
In the primary care environment, cognitive impairment in elderly patients is a prevalent problem. A thorough background check, medical examination, lab tests, neuroimaging studies, and a comprehensive cognitive evaluation are all components of the primary care measures for cognitive impairment. For cognitive evaluation, a brief screening instrument is more practical, nevertheless. A thorough cognitive examination should be carried out in order to match a deterioration in memory with a more extensive clinical presentation.
Main Body
The first step to screening for dementia in a 75-year-old patient is to rule out other possible conditions. For instance, it is crucial to screen for delirium prior to evaluating cognition since delirium and Alzheimer’s disease are frequently confounded. Delirium may be evaluated via the Confusion Assessment Method (CAM) (Ranjit et al., 2020). In addition to this, to exclude reversible disorders, including normal pressure hydrocephalus, and to gauge the degree of brain shrinkage, neuroimaging tools of the head, such as a CT scan, can be performed (Ranjit et al., 2020).
Prior to doing a cognitive exam, anxiety and depressive disorders should be screened as they might influence cognition (Ranjit et al., 2020). For instance, depression is characterized by a change in emotions and moods that has been present for at least several weeks (Tetsuka, 2021). Delirium is a change of mood that comes rapidly over the course of several hours or days (Tetsuka, 2021). Meanwhile, dementia is a condition that develops slowly and is accompanied not only by emotional changes but memory issues as well.
Various tests can be applied to determine the presence of dementia or the intensity of the condition. A quick cognitive evaluation test called Mini-Cog can be administered in a general care environment. The test is divided into two sections: a clock painting and the capacity to remember words correctly (Ranjit et al., 2020).
For a sum of 5, 1 point is awarded for each word that is remembered, and either 0 or 2 points are awarded for depicting the clock (Ranjit et al., 2020). A meta-analysis found that the Mini-sensitivity Cogs and accuracy for diagnosis were both 91% (Ranjit et al., 2020). However, a more thorough cognitive evaluation test should be conducted after a positive Mini-Cog result.
Among the most frequently applied examinations for cognitive evaluation and one of the measures used to check for Alzheimer’s disease is the Mini-Mental Status Exam (MMSE). There are a total of twenty questions on it, and the highest possible score is thirty (Ranjit et al., 2020). Results have been adjusted to indicate the level of cognitive damage despite the fact that it is a screening tool. The test is used to categorize dementia intensity in people with confirmed dementia into low, medium, and extreme kinds (Ranjit et al., 2020). Therefore, it is necessary to rule out other conditions and administer several tests.
Still, there are red flags that can indicate the presence of dementia in older patients. For instance, behavioral indicators of dementia include repeated phone calls, appointments with the doctor, or attendance at the emergency room (Molnar & Frank, 2020).
Moreover, medication or instruction noncompliance or loss of capacity to manage other diagnosed conditions that were previously managed well are indicators as well (Molnar & Frank, 2020). Finally, one must be aware of changes in behavior and appearance, along with word formation difficulty and a decline in social interaction (Molnar & Frank, 2020). Such flags alone cannot precisely identify a patient with dementia, but they can corroborate a diagnosis.
Conclusion
Hence, to correlate a decline in memory with a more significant clinical presentation, a comprehensive cognitive assessment should be performed. In order to examine a 75-year-old patient for dementia, other potential illnesses must first be ruled out. There are several tests available, including the Mini-Cog, a brief cognitive assessment exam that may also be used in a general healthcare setting. The Mini-Mental Status Exam is one of the most regularly used tests for evaluating cognitive function and one of the tests for Alzheimer’s disease. Finally, it is crucial to be aware of the warning signs of dementia in elderly individuals.
References
Molnar, F., & Frank, C. (2020). Cognitive screening of older patients. Canadian Family Physician, 66(1), 40. Web.
Ranjit, E., Sapra, A., Bhandari, P., Albers, C. E., & Ajmeri, M. S. (2020). Cognitive assessment of geriatric patients in primary care settings. Cureus, 12(9), e10443. Web.
Tetsuka, S. (2021). Depression and dementia in older adults: A neuropsychological review. Aging and Disease, 12(8), 1920–1934. Web.