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Cognitive Impairment in the Elderly – Recognition, Diagnosis and Management

Although a substantial proportion of individuals over age 50 have reduced ability to absorb naturally occurring vitamin B12, they are able to absorb the crystalline form. Thus, all individuals over the age of 50 should be encour­ aged to meet their Recommended Dietary Allowance (RDA) (2.4 µg/day) for vitamin B12 by eating foods fortified with vitamin B12 such as fortified cereals, or by taking the crystalline form of vitamin B12 supplements. Women and Iron Based on blood values, substantial numbers of adolescent females and women of childbearing age are iron deficient. Thus, these groups should eat foods high in heme­iron (e.g., meats) and/or consume iron­rich plant foods (e.g., spinach) or iron­fortified foods with an enhancer of iron absorption, such as foods rich in vitamin C (e.g., orange juice). Appendix B­3 lists foods that can help increase iron intake and gives their iron and calorie content. . | GUIDELINES PROTOCOLS ADVISORY COMMITTEE Cognitive Impairment in the Elderly -Recognition Diagnosis and Management Effective Date July 15 2007 Scope This guideline summarizes current recommendations for recognition diagnosis and longitudinal management of cognitive impairment and dementia in the elderly. Where the guideline refers to people affected by dementia this indicates not only the person with dementia but also the people in their network of support . Summary Recommendation Care Objectives The primary care objectives are to encourage early recognition and assessment of cognitive impairment and to support general practitioners in the development of a comprehensive care plan that includes the identification of community resources for the people affected by dementia. A summary is provided for this guideline and can be used as a worksheet in the physician s office. Part I Recognition and Diagnosis Recommendation 1 Recognition a. General population screening in asymptomatic individuals is not recommended at this time. b. Cognitive impairment should be suspected when there is a history that suggests a decline in occupational social or day-to-day functional status. This might be directly observed or reported by the patient concerned family members friends and or caregivers. Symptoms of Cognitive Impairment Asks the same question repeatedly Cannot remember recent events Cannot prepare any part of a meal or may forget that they have eaten Forgets simple words or forgets what certain objects are called Gets lost in own neighbourhood and does not know how to get home Dresses inappropriately e.g. may wear summer clothing on a winter day Has trouble figuring out a bill or cannot understand concepts such as birthdays Repeatedly forgets where things were left puts things in inappropriate places Has mood swings for no apparent reason and especially without prior psychiatric history Has dramatic personality changes may become suspicious withdrawn apathetic fearful or .