Thinking About Thinking™ – What do I do next when I have a patient with a thinking problem? Office visit

What do I do next when I have a patient with a thinking problem?  Office visit

The scenarios are endless so let’s narrow this down to an office visit.  Perhaps you have implemented the annual wellness visit and a patient scores poorly on the simple cognitive test.  Or a concerned daughter in law tips you off that mom isn’t as sharp as she war. Or least likely, the patient themselves mentions changes in their thinking.

There are things to be done, especially in primary practice, without immediately assuming the worst (irreversible dementia) or sending someone off to likely wait for a specialist consult.  

A new resource called KAER could guide your approach.  Developed by a blue-ribbon expert panel convened by the Gerontological Society of America that included several practitioner associations, it suggests four steps (and provides options for routines that you can build into practice) for each step.

K-Kickstart the conversation

A-Assess for cognitive impairment


R-Refer to community resources. 

Worth noting: The workgroup identified six sets of recommended components of a diagnostic evaluation for dementia and found that all endorse a central for PCP’s in diagnosing dementia in older adults and that most of what needs to be done in evaluating a patient for dementia can be done or coordinated through primary care.  These steps include blood tests, a drug review, and gathering information about the onset, course and nature of memory and other cognitive impairments and any associated behavioral, medical, or psychological issues, including comorbid medical conditions, alcohol and other substance use, vision and hearing problems, and depression.

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