A 70-year-old man is brought to your clinic by his son, concerned about his memory over a few months.The patient has hypertension, dyslipidemia, osteoarthritis and overactive bladder. His medications include Hydrochlorothiazide 12.5mg + Losartan 50mg daily, atorvastatin 10mg daily, tramadol 50mg twice daily, solifenacin 10mg daily and bromazepam 3mg at night.
He was treated for depression 5 years ago and UTI 3 months ago. Father had a history of stroke.
History,Red flags and Referral
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Red Flags
**1. Severe memory loss
- Aggressive behaviour
- Suicidal ideation
- Risk to self with home appliances like gas cooker, electricity
- Getting lost, unable to find way back home**
Referral
1. Mental Health Crisis Team / Memory clinic to address significant symptoms of psychosis,
depression, risky behaviour & mental capacity issues.
2. MDT team comprised of Physicians, neuropsychiatrist, occupational therapist, Physiotherapist,
social services and Family/ Friends.
1. General & Vitals
Check for hypertension, signs of systemic illness.
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4. Functional Assessment
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Ability to manage medications, finances, cooking
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Differential Diagnoses
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Medication-induced (bromazepam, tramadol, solifenacin)
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Delirium / metabolic causes (UTI, electrolytes)
Other neurodegenerative: Lewy body, frontotemporal dementia
Investigations
Labs: CBC, electrolytes, renal & liver function, glucose, TSH, B12, folate
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Optional: neuropsych testing, cardiovascular assessment if vascular cause suspected
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