21
STEP 8: Perform limited laboratory testing
➤ Routine laboratory testing (CBC, basic metabolic panel [BMP], liver
function test [LFT]).
➤ TSH, vitamin B12.
➤ In select cases, HIV and syphilis testing may be warranted.
Table 7. Selected Screening Tools for Cognitive Impairment
MOCA
11
Montreal Cognitive
Assessment
(normal >26/30)
BIMS
12
Brief Interview for
Mental Status (normal
>13/15), part of MDS
SLUMS
13
Saint Louis University
Mental Status
(normal >25/30)
• Visuospatial/Executive
• Naming
• Memory
• Attention
• Language
• Abstraction
• Delayed recall
• Orientation
• Registration of 3 words
• Orientation to month,
year, day
• Delayed recall
• Orientation to week,
year, location
• Attention
• Animal fluency
• 5 object recall
• Visuospatial
STEP 9: Consider neuro-imaging
➤ CT or MRI to be performed at least once since onset of symptoms.
➤ More advanced neuro-imaging such as volumetric MRI, functional PET
or amyloid scans have not been studied in nursing home residents
but are reserved for evaluation of dementia at specialized memory
centers and research.
STEP 11: Consider formal neuropsychological testing in
cases in which the diagnosis remains uncertain
STEP 10: Screen for depression
➤ Recognize that depression can coexist in dementia. As such,
appropriate to use specific screening tools, such as Cornell Scale
(refer to Appendix E) and PHQ-9 (refer to Appendix F).
STEP 12: Assess stage of dementia
➤ Consider FAST scale (refer to Table 8).
➤ Remember, patients do not skip stages.
➤ To be eligible for hospice, generally have to be stage 7C or beyond.
