What are the considerations for ordering an RSClinN+ (Rapid Screening Clinical Neuroscience+) test for a patient with suspected neurological or psychiatric disorders, such as cognitive decline, memory loss, or mood changes?

RSClinN+ Test: Clinical Considerations

The "RSClinN+" test does not appear in any established medical literature, guidelines, or FDA-approved diagnostic panels for neurological or psychiatric disorders, and therefore cannot be recommended for clinical use. No major guideline organization (ACR, AAN, Alzheimer's Association, Canadian Consensus Conference) references this test in their diagnostic algorithms for cognitive decline, delirium, psychosis, or mood disorders.

What You Should Order Instead

For Cognitive Decline and Memory Loss

When cognitive concerns are present, proceed with validated cognitive assessments first, followed by targeted laboratory and imaging studies based on clinical presentation. 1

Initial Office-Based Assessment

• Use validated cognitive screening tools such as MoCA (more sensitive for mild-moderate decline) or MMSE if MoCA is normal but suspicion remains 2
• Obtain collateral history from an informant about functional decline in instrumental activities of daily living, missed appointments, medication management difficulties, or behavioral changes 1
• Screen for "red flags" requiring urgent evaluation: focal neurological deficits, rapid progression, fluctuating course, severe mood/behavioral disturbance, or movement disorders 1

Essential Laboratory Testing (Tier 1)

Order these tests for all patients with cognitive concerns to identify reversible causes: 3, 2

• Complete blood count and comprehensive metabolic panel
• Thyroid function tests (TSH)
• Vitamin B12 and folate levels
• Consider homocysteine if B12 is borderline

These reversible causes are frequently treatable and must not be missed - vitamin B12 deficiency and hypothyroidism can both cause memory impairment and neuropsychiatric symptoms. 3

Neuroimaging Decisions

For patients with cognitive decline WITHOUT high-risk features, neuroimaging yield may be low but MRI is preferred over CT when performed. 1

Order urgent head CT for patients with: 1

• Anticoagulant use or coagulopathy
• Hypertensive emergency
• Clinical suspicion for intracranial infection, mass, or elevated intracranial pressure
• Focal neurological deficits

Consider MRI (preferred over CT) for: 1, 2

• Atypical presentations (aphasia, apraxia, agnosia, prominent language difficulties)
• Early-onset dementia (age <65)
• Rapidly progressive cognitive decline
• When CT is unrevealing but clinical suspicion remains high
• To detect small infarcts, encephalitis, medial temporal lobe atrophy, or subtle structural abnormalities

For New Onset Psychosis

Neuroimaging decisions depend on presence of neurological signs. 1

Order head CT or MRI when: 1

• Focal neurological deficits are present
• Atypical features suggest organic causes (temporal lobe pathology, autoimmune disease, encephalitis)
• First psychotic episode at advanced age (warrants comprehensive cognitive evaluation as this may signal underlying dementia) 3, 4

The American College of Emergency Physicians found inadequate literature supporting routine neuroimaging for new onset psychosis WITHOUT neurological deficits - individual risk assessment should guide the decision. 1

For New Onset Delirium

Delirium must be excluded before diagnosing dementia, as it presents with fluctuating cognitive and behavioral changes. 3

Order head CT for delirium when: 1

• Suspected stroke, focal deficit, seizure, head trauma, or severe headache
• Not responding to initial management of suspected underlying medical cause
• High clinical suspicion for intracranial pathology

The diagnostic yield is low in absence of focal neurological deficits or trauma signs, so clinical judgment is essential. 1

For Mood Changes in Older Adults

Late-onset depression can signal underlying dementia or mimic pseudodementia - these patients warrant cognitive assessment even if mood symptoms are prominent. 3, 4

First major psychiatric episode at advanced age (including mania, psychosis, anxiety, depression) requires comprehensive cognitive evaluation. 1, 3, 4

When to Refer for Neuropsychological Testing

Order formal neuropsychological evaluation when: 1, 2

• Patient/caregiver reports concerning symptoms but office testing is normal
• Office examination is abnormal but interpretation is uncertain due to complex clinical profile
• Atypical presentations require detailed cognitive profiling
• Need to distinguish neuropsychiatric disorders from medical/emotional comorbidities

The evaluation should minimally assess: delayed free and cued recall/recognition, attention, executive function, visuospatial function, and language. 1

Common Pitfalls to Avoid

• Do not screen asymptomatic individuals - cognitive testing to screen asymptomatic adults for MCI or dementia is not recommended, even with risk factors like family history 1
• Do not presume late-onset psychiatric symptoms are primary psychiatric disorders - they may signal underlying neurodegenerative disease 3
• Do not neglect reversible causes - B12 deficiency and hypothyroidism are frequently treatable 3
• Do not order neuroimaging reflexively - in stable patients without focal deficits or high-risk features, the yield may be low 1
• Cognitive complaints correlate more with mood and mental health than actual cognitive status - broad evaluation is essential 5