By rray, 3 June, 2024 Do not dismiss sx not explained by or out of proportion to objective findings These are common even if etiology duration not fully understood 3
By rray, 3 June, 2024 Evaluate the overall trajectory of sx which often fluctuate and recur Support levels may change over time 7
By rray, 3 June, 2024 Evaluate the impact of sx on QOL even if individual sx alone may not warrant referral 7
By rray, 3 June, 2024 Eval Consider primary causes of cognitive impairment and contributing factors based on hx s sx 5
By rray, 3 June, 2024 Refer to neurology if neuro s sx urgent eval for focal or progressive features Refer pts w screen for cognitive sx to specialist neuropsych speech language path OT w expertise in formal cognitive assessment and tx Consider sleep specialty referral if need
By rray, 3 June, 2024 Brain imaging Consider neuroimaging for new worsening focal neuro deficits cognitive sx 1
By rray, 3 June, 2024 Labs CBC CMP B12 thiamine folate homocysteine 1 25 dihydroxy vit D magnesium LFTs TSH free T3 free T4 if high risk consider syphilis and HIV testing other tests based on specific s sx 1
By rray, 3 June, 2024 Exam Targeted based on HPI Check T RR HR BP and orthostatic HR BP cardiac and pulm exam resting and ambulatory pulse ox 3 6 assess endurance e g 30 sec sit to stand 6 or 10 min walk test 2 min step seated or standing 4 6 min walk test while monitoring HR
By rray, 3 June, 2024 Consider standardized assessments to evaluate and follow sx over time 3 nbsp nbsp Montreal Cognitive Assessment MoCA nbsp nbsp Mini Mental Status Examination MMSE nbsp nbsp Compass 31 for dysautonomia nbsp nbsp Neurobehavioral Symptom Inventory