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The Initial Visit to the Doctor for a Dementia Work-up: What to Expect Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry What to Bring – Copies of medical summaries – List of current medications • When in doubt, bring the bottles of all the medications being taken • Remember both prescription as well as over the counter medications – Original studies • Reports • Actual scans – CAT and MRI Telling the Story • What? – Short term memory – Long term memory – Particular difficulty with speech • • • • Decreased number of words Increased time to respond Word finding difficulty “tip of the tongue” Telling the Story • What? – Difficulty with activities of daily living – both basic and complex • • • • Self care Driving Balancing a checkbook Cooking – Changes in personality Telling the Story • When? – The changes began to be noticeable – The changes became much worse – Use the holidays as a marker when trying to estimate the length of time • “he seemed ok when I last visited at Thanksgiving but at New Year’s he had stopped driving because of constantly getting lost” Telling the Story • When? – Longterm – over a defined length of time – Episodic – when symptoms start and when they end – Consider if any particular stimulus or event seems time-related Telling the Story • Why? – – – – Why now is an evaluation being sought? Issues of safety Issues of care Any particular stressors? Telling the Story • Who? – Who conducted any previous evaluations? – Who is the current treating physician? – Who will be doing the follow-up after this evaluation? – Who is the primary caregiver? – Who lives in the same residence? Telling the Story • Where? – Where does the patient live? – Is placement in a care facility being considered and if so – where? The Clinic Visit • Be prepared to wait – bring a book or magazines • Check to see if any tests are order to be done before the clinic visit – if done at an outside facility – bring the results • Be prepared with insurance/funding information The Clinic Visit • History of present illness • Mental exam testing – “paper and pencil” • Physical exam • Neurological exam • Review of lab values and studies UF Memory Disorder Clinic • Evaluation by a neurologist • Evaluation by Dr. Heilman • Psychiatric evaluation by Dr. Cheong • Psychosocial inventory and counseling by Dr. Leilani Doty Referral Shands at UF Inpatient Geriatric Psychiatry Unit Intake Coordinator 352-265-5411 UF Memory Disorder Clinic 352-392-3491 GO GATORS!