Workup for Elderly Female with Dementia Reporting Feeling Cold
Order a comprehensive metabolic panel, complete blood count, thyroid function tests (TSH, free T4), and urinalysis to identify reversible medical causes such as hypothyroidism, anemia, infection, dehydration, or metabolic disturbances that commonly drive behavioral symptoms in dementia patients who cannot clearly communicate discomfort. 1, 2
Systematic Investigation of Underlying Causes
The complaint of "always being cold" in a dementia patient requires systematic evaluation for medical triggers before attributing it to behavioral symptoms alone. This approach follows the INVESTIGATE step of dementia management. 1, 2
Essential Laboratory Testing
- Thyroid function tests (TSH, free T4): Hypothyroidism causes cold intolerance and can worsen cognitive function in elderly patients 3
- Complete blood count: Anemia contributes to cold sensitivity and fatigue, and is common in elderly populations 1
- Comprehensive metabolic panel: Identifies electrolyte imbalances, renal dysfunction, and glucose abnormalities that may manifest as temperature dysregulation 1
- Urinalysis with culture: Urinary tract infections frequently present atypically in dementia patients and can cause behavioral changes including temperature complaints 1
Additional Assessments to Consider
- Vital signs including core temperature: Document actual body temperature versus subjective complaint to differentiate true hypothermia from perception issues 1
- Medication review: Identify anticholinergic medications (diphenhydramine, oxybutynin, cyclobenzaprine) that impair thermoregulation and worsen cognitive function 4, 2
- Pain assessment: Use systematic pain evaluation tools, as untreated pain is a major contributor to behavioral disturbances in patients who cannot verbally communicate discomfort 1, 5, 6
Physical Examination Focus
- Cardiovascular examination: Assess for peripheral vascular disease, heart failure, or arrhythmias causing poor perfusion 3
- Thyroid palpation: Evaluate for goiter or thyroid nodules 3
- Skin examination: Check for signs of hypothyroidism (dry skin, hair loss), poor nutrition, or pressure ulcers 2
- Neurological examination: Focal deficits may suggest stroke or other structural brain pathology contributing to temperature dysregulation 3
Environmental and Functional Assessment
- Home temperature evaluation: Ensure adequate heating and appropriate clothing layers are available 1
- Nutritional status: Malnutrition and dehydration impair thermoregulation and are common in dementia patients 1, 2
- Activity level: Reduced mobility decreases heat generation and circulation 1
Common Pitfalls to Avoid
Do not dismiss the complaint as purely behavioral without ruling out medical causes first. Dementia patients often use non-specific complaints to express underlying physiologic needs they cannot clearly articulate. 5, 6 The Serial Trial Intervention approach emphasizes that behaviors in dementia frequently represent unmet needs requiring systematic assessment. 5
Avoid attributing symptoms to "just dementia" without investigating treatable conditions. Infections, metabolic disorders, and medication side effects commonly present atypically in elderly patients with cognitive impairment. 1, 7