The Initial Visit to the Doctor for a Dementia Work-up: What to Expect Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry

What to Bring –Copies of medical summaries –List of current medications When in doubt, bring the bottles of all the medications being taken Remember both prescription as well as over the counter medications –Original studies Reports Actual scans – CAT and MRI

Telling the Story What? –Short term memory –Long term memory –Particular difficulty with speech Decreased number of words Increased time to respond Word finding difficulty “tip of the tongue”

Telling the Story What? –Difficulty with activities of daily living – both basic and complex Self care Driving Balancing a checkbook Cooking –Changes in personality

Telling the Story When? –The changes began to be noticeable –The changes became much worse –Use the holidays as a marker when trying to estimate the length of time “he seemed ok when I last visited at Thanksgiving but at New Year’s he had stopped driving because of constantly getting lost”

Telling the Story When? –Longterm – over a defined length of time –Episodic – when symptoms start and when they end –Consider if any particular stimulus or event seems time-related

Telling the Story Why? –Why now is an evaluation being sought? –Issues of safety –Issues of care –Any particular stressors?

Telling the Story Who? –Who conducted any previous evaluations? –Who is the current treating physician? –Who will be doing the follow-up after this evaluation? –Who is the primary caregiver? –Who lives in the same residence?

Telling the Story Where? –Where does the patient live? –Is placement in a care facility being considered and if so – where?

The Clinic Visit Be prepared to wait – bring a book or magazines Check to see if any tests are order to be done before the clinic visit – if done at an outside facility – bring the results Be prepared with insurance/funding information

The Clinic Visit History of present illness Mental exam testing – “paper and pencil” Physical exam Neurological exam Review of lab values and studies

UF Memory Disorder Clinic Evaluation by a neurologist Evaluation by Dr. Heilman Psychiatric evaluation by Dr. Cheong Psychosocial inventory and counseling by Dr. Leilani Doty

Referral Shands at UF Inpatient Geriatric Psychiatry Unit Intake Coordinator UF Memory Disorder Clinic

GO GATORS!