Examining the Patient
The emergency physician can use three components of examination to help evaluate patients with cognitive impairment.
Mental state
Mental state examinations can be used to help elucidate any patterns more consistent with mental illness.
Physical examination
Physical examination can be useful to the emergency physician in several ways:
- It can identify reversible causes of delirium such as sepsis or injury
- An unkempt patient may reveal difficulties with the social care of the patient
- The patient’s interaction during the examination may indicate their degree of impairment and there may be clues which indicate a dementia subtype
For these reasons the physical examination should include:
- A full set of observations
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Careful examination of all systems:
- Cardiovascular – could there be heart failure or infarction?
- Respiratory – could there be a covert pneumonia?
- Neurological – is there any focal neurology, Parkinsonism or signs of head injury?
- Gastrointestinal – could the patient be constipated?
- Genitourinary – could there be a UTI or retention?
- Dermatological – are there any pressure sores or cellulitis?
- A general examination to identify any injuries causing the patient distress
Clinical cognitive assessment
Clinical cognitive assessments can be used to identify which modalities of cognition are impaired, and to what degree (this is discussed in the next section).