From the Guidelines
The evaluation and management of a patient presenting with unspecified symptoms should start with a thorough history and physical examination, considering referral to a specialist if atypical cognitive abnormalities, sensorimotor dysfunction, or accompanying mood/behavioral disturbances are present. When evaluating patients with unspecified symptoms, it is crucial to consider the potential for underlying neurodegenerative diseases, such as Alzheimer's disease or related disorders, as highlighted in the Alzheimer's Association clinical practice guideline 1. The guideline recommends that patients with atypical cognitive abnormalities, sensorimotor dysfunction, or accompanying mood/behavioral disturbances should be strongly considered for referral to a specialist or a dementia subspecialist.
Some key considerations in the evaluation of patients with unspecified symptoms include:
- Obtaining a detailed account of symptom onset, duration, severity, exacerbating and alleviating factors, and associated symptoms
- Performing a comprehensive physical examination, including vital signs, general appearance, and systematic assessment of all body systems
- Initial laboratory testing, such as complete blood count, comprehensive metabolic panel, urinalysis, and other tests guided by clinical suspicion
- Imaging studies, such as chest X-ray or abdominal ultrasound, may be warranted based on symptom localization
- Management should address immediate concerns, such as pain or distress, using appropriate medications, ensuring adequate hydration and rest while awaiting diagnostic results
It is essential to note that delays in accurate diagnosis and appropriate management of patients with atypical and young-onset dementias may cause substantial distress, harm, and costs to patients, families, and society, as emphasized in the guideline 1. Therefore, a thorough and systematic approach to evaluating patients with unspecified symptoms is critical to identify potential causes and enable targeted treatment.
From the Research
Evaluation and Management of Unspecified Symptoms
The evaluation and management of a patient presenting with unspecified symptoms can be challenging.
- A thorough medical history and physical examination are essential in identifying potential causes of the symptoms.
- Laboratory tests, such as blood work and imaging studies, may be ordered to help diagnose the underlying condition.
- The transferrin saturation (TSAT) ratio, which is the ratio of serum iron to total iron-binding capacity, can be used to assess iron deficiency and iron overload 2, 3.
- A TSAT ratio between 24% and 40% is associated with the greatest survival, while both low and high TSAT ratios are significantly and independently associated with increased total and cardiovascular mortality 3.
Diagnostic Approaches
- Infective endocarditis, a condition that involves infection of the endocardial surface of the heart, can present with unspecified symptoms and requires a multidisciplinary approach to diagnosis and management 4.
- Integrated diagnostics, which combines imaging, pathology, and laboratory tests with advanced information technology, has the potential to revolutionize the diagnosis and therapeutic management of human diseases, including those causing the largest number of worldwide deaths 5.
- The microbiology laboratory plays a critical role in the diagnosis of infectious diseases, and a close working relationship between physicians and microbiologists is essential for effective diagnosis and treatment 6.
Laboratory Tests and Imaging Studies
- Laboratory tests, such as blood cultures and complete blood counts, can help identify potential causes of unspecified symptoms.
- Imaging studies, such as echocardiography and computed tomography (CT) scans, can help diagnose conditions such as infective endocarditis and cardiovascular disease.
- The choice of laboratory tests and imaging studies depends on the patient's medical history, physical examination, and symptoms, as well as the suspected underlying condition.