From the Guidelines
The next step for a patient with a normal dementia panel should be to monitor cognitive function and fully evaluate the patient when impairment is noted, as recommended by the Journal of Internal Medicine in 2021 1. This approach is crucial in increasing timely diagnosis and should involve a brief, self-administered, care partner-focused assessment of the patient’s cognition/functioning before proceeding with a standard structured assessment of the patient’s cognition/functioning. Some key points to consider in the evaluation process include:
- Obtaining a comprehensive medical history and performing an examination focusing on cognitive function, behaviour/neuropsychiatric status, ADLs, medications, medical comorbidities, and laboratory testing
- Considering neuropsychological evaluation to establish the extent and severity of a patient’s cognitive impairment objectively
- Monitoring patients serially and considering subspecialty consultation
- Conducting serial assessment with the same instrument, preferably at intervals of at least 6 months to reduce practice effects artificially inflating test scores As noted in the study 1, a ‘normal’ score on a cognitive screening tool used by itself may not necessarily exclude subtle impairment nor substantial functional or behavioural problems, highlighting the importance of a comprehensive evaluation. Regular follow-up at intervals of at least 6 months is essential to determine whether the patient is declining, improving, or staying the same, and to track the progression of cognitive parameters over time 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for a Patient with a Normal Dementia Panel
- If a patient has a normal dementia panel, the next steps may involve further evaluation to determine the underlying cause of cognitive decline, as dementia is a clinical diagnosis that requires comprehensive evaluation of patient cognitive and functional abilities, diagnostic laboratory evaluation, and brain imaging 2.
- A thorough medical history and physical examination may reveal important clues about the potential underlying causes of cognitive decline, and validated cognitive assessment tools can help clinicians identify the extent and nature of cognitive deficits 2.
- Brain imaging, such as MRI or CT scans, may be used to identify structural changes, including focal atrophy, infarcts, and tumors, that may not be identified on physical examination 3, 4.
- Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory 3.
- Functional and molecular nuclear medicine imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) techniques may provide valuable information about the underlying pathological processes, many years before the appearance of clinical symptoms 5, 6.
Considerations for Further Evaluation
- The choice of diagnostic tests, such as MRI, CT, or lumbar puncture, may depend on variables such as age, gender, and disease severity, as well as the type of dementia disorder suspected 4.
- Nonpharmacologic approaches, including cognitively engaging activities, physical exercise, and socialization, may be beneficial for patients with dementia, and pharmacologic approaches can provide modest symptomatic relief 3.
- The use of telemedicine for dementia diagnosis is still in its infancy, but research suggests that it has the potential to be an effective and convenient tool for evaluating patients with suspected dementia 2.