Patients often wonder if they are mentally ‘losing it.’ They
will forget why they have walked into a room or wonder what it was they were
supposed to buy at the market. The overwhelming fear is developing dementia.
The thirty second test for dementia: it’s not remembering
where you put your keys, but rather looking at the keys and wondering what they
are for. It’s not quite a simple as that but physicians do have tools to assess
cognitive function. When assessing a patient it’s important to take into account
the underlying intelligence – the proxy for this is years of education. We
expect better test scores from a Ph.D than from a grade school graduate. Also,
patients who don’t feel well or who are in an unfamiliar environment may not
score well.
Even patients who score well on a cognitive assessment panel
may have difficulty with everyday tasks such as handling money or finding their
way around familiar streets. Information from family or friends is helpful,
particularly when determining fitness to drive. Such collateral history may be
needed in judging executive function. The inability to self-regulate and plan may
be a clue to specific underlying brain disorders.
One cannot do a cognitive self assessment: the people around
the patient will notice a problem. Since medical problems may present as
cognitive decline, it’s important to obtain a complete medical evaluation.
A special report from Johns Hopkins Press.
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