Читать книгу The Small Guide to Alzheimer's Disease - Gary Small - Страница 16

When patients and their families come to me for help with cognitive issues, I take a systematic approach. I try to assess the clinical issues at hand, but I also need to gain the patient’s trust if we are to move forward together with a treatment plan. Educating people at the outset about what to expect is an important first step to building that trust—with both patients and their families. Unless the patient has very mild memory complaints, family members usually accompany them to the first visit.

Following introductions, I explain what I hope to accomplish with them at the initial appointment. I also ask patients and their family members about their expectations so I can better understand what they want to accomplish. I describe the type of information that I need to obtain in order to understand the patient’s particular cognitive problems and plan a treatment strategy.

Summary of Assessment Procedures

 • Obtain a history of the symptoms from patients, caregivers, and family members. This includes the date of onset of problems, other medical conditions, and any medications being taken.

 • Perform a neurological and general physical examination as well as a mental status exam using standardized rating scales, such as the Mini Mental State Examination (MMSE) or the Montréal Cognitive Assessment (MoCA) test.

 • Determine the patient’s functional abilities and level of independence.

 • Draw blood for laboratory testing to assess whether medical illnesses are present.

 • Perform a brain scan, such as a magnetic resonance imaging (MRI), a computed tomography (CT), or possibly a position emission tomography (PET) study.

Although I first meet with everyone together, I let them know that I will spend time alone with each of them during the appointment. Explaining this at the beginning of the visit helps minimize any anxious or paranoid feelings that patients or family members may experience when I request to speak with individuals alone. It also makes it easier to perform cognitive testing on the patient without caregivers cueing the patient and biasing the assessment. Further, those individual meetings allow family members to speak more freely about their concerns when the patient is out of earshot.