Examkin

Question

Difficulty: EasyNeurocognitive Disorders

A 72-year-old woman is brought to the clinic by her daughter due to a 1-year history of progressive memory loss, misplacing items, and getting lost in familiar neighborhoods. Arrange the following steps in the most appropriate chronological order for the initial diagnostic evaluation of this patient's progressive cognitive decline.

  1. 1Obtain a detailed clinical history, including collateral information, and perform a physical examination.
  2. 2Administer an objective cognitive screening assessment (e.g., Montreal Cognitive Assessment).
  3. 3Order initial laboratory testing (e.g., complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, vitamin B12).
  4. 4Obtain structural neuroimaging of the brain (e.g., magnetic resonance imaging).

Answer

The diagnostic workup for cognitive decline sequentially involves: history and physical examination, objective cognitive screening, laboratory testing for reversible causes, and finally structural neuroimaging.
The standard approach to evaluating a patient with progressive cognitive decline follows a stepwise sequence. It begins with a comprehensive history and physical exam (including collateral history) to define the clinical syndrome. Next, an objective cognitive screening tool (e.g., MoCA, MMSE) is administered to quantify the impairment. Once impairment is confirmed, laboratory tests (TSH, Vitamin B12, CMP, CBC) are drawn to rule out reversible metabolic causes. Finally, structural neuroimaging (non-contrast CT or MRI) is obtained to rule out structural lesions (such as subdural hematoma, tumors, or normal pressure hydrocephalus) and support specific neurodegenerative diagnoses.

Step-by-Step Solution

1
Identify the patient's presentation as suspected major neurocognitive disorder (dementia).
The patient has a 1-year history of progressive functional impairment and memory loss.
Recognizing the broad clinical syndrome guides the standard algorithmic workup.
2
Place the history and physical examination as the first action.
History and physical is ranked first.
Patient assessment universally begins with direct clinical evaluation and collateral information gathering.
3
Determine the next step to confirm the suspected diagnosis.
Objective cognitive screening is ranked second.
Subjective complaints must be verified and quantified using standardized tools like the MMSE or MoCA.
4
Sequence the diagnostic tests to rule out secondary causes.
Laboratory testing is ranked third, followed by neuroimaging as the final step in this initial workup list.
Blood work is a minimally invasive way to rapidly identify reversible metabolic causes (e.g., hypothyroidism), while structural neuroimaging completes the standard diagnostic criteria for major neurocognitive disorders by ruling out space-occupying lesions or vascular disease.

Key Concept

The standard diagnostic sequence for evaluating progressive cognitive decline.
Rate this question

Topics

Neurocognitive Disorders

More questions from this topic