ST3 Geriatric Medicine Interview
A patient is referred to you as they are concerned about loss of memory: outline your assessment
A good answer will acknowledge probable causes and discuss logical approach
Consider the most likely causes including dementia, mild cognitive impairment etc.
• The patient should be informed early in history interview of common possible causes including ‘normal’ ageing; mild cognitive impairment; dementias of several causes.
• They should appreciate a variety of conditions can cause memory impairment which include mood disorders (depression) which are important to exclude.
Understands the commonly used tools for cognitive assessment
• The assessment follows most diagnostic courses but it is important to recognize importance of certain areas.
• These should include relevant past history and medication; examination especially of nervous system; appreciates how to use standard examinations of cognition such as Mini Mental Status Examination; understands how to use results of MMSE or other assessment tools in diagnostic process.
Recognize importance of carer information to contextualise the problem presented
• The information of carer or regular attendant is essential.
• They can corroborate historical answers and provide observers view of patients problems.
• Especially important in cases were patient is vague or limited in historical detail.
Investigation portfolio contemporary
• The standard investigations should be presented including basic biochemical screen including renal and liver function; thyroid function; Vitamin B 12 levels; brain imaging.
• This includes when additional investigations may be needed of specific nature with indication.
• Understands were additional assessment is needed such as neuropsychological tests
• Appreciate the elements of the National Dementia Strategy which relate to the case of patient with undiagnosed concerns about cognitive impairment.
Pitfalls to Avoid
• Does not appreciate the definitions and prognostic relevance of Mild Cognitive Impairment and its subtypes.
• Fails to consider common non-degenerative conditions such as depression as cause of subjective memory complaint.