DIAGNOSIS CHECKLIST
for Cognitive impairment

Why: to determine if acute or chronic. If acute in nature must consider delirium as possible cause of cognitive impairment. Delirium is an acute confusional state due to many causes e.g. infection, drug intoxication, alcohol withdrawal, liver failure, kidney failure, hypoxia, low blood sugar, stroke, heart attack or head injury.

Why: many symptoms can be used to explain cognitive impairment e.g. forgetfulness, poor concentration, confusion, disorientation, dementia, learning disability, mental retardation, delusion, paranoia, hallucinations, disorganization, indecisiveness.

Why: if a child must consider attention deficit hyperactivity disorder, learning disorders , causes of mental retardation e.g. fragile X syndrome, tuberous sclerosis, Down syndrome, trisomy 18, agenesis of the corpus callosum, cerebral palsy, Chiari malformation, fetal alcohol syndrome, hydrocephalus, Rett's syndrome, Soto's syndrome, microcephaly, autism, Duchenne muscular dystrophy.

Why: may detect prenatal infections, prenatal drugs and toxins, birth trauma, neonatal infection as a possible cause of cognitive impairment.

Why: e.g. if symptoms are worse in the late afternoon and at night delirium ( acute confusional state) is most likely.

Why: patients with cerebral arteriosclerosis e.g. stroke or with AIDS notice their memory slipping whereas patients with Alzheimer's disease are unaware of memory loss.

Why: may suggest subdural haematoma, extradural haematoma or concussion.

Why: certain medications may cause intoxication e.g. anticonvulsants, anticholinergics, anti-anxiety medications, opiates.

Why: e.g. high blood pressure, high cholesterol, diabetes, smoking, family history - can assess risk of multi-infarct dementia.

Why: e.g. developmental delay, genetic disorders, learning disabilities, Alzheimer's disease, Huntington's disease, multiple sclerosis, depression.

Why: to assess chance of alcohol abuse, Wernicke-Korsakoff syndrome, hepatic encephalopathy, subdural or extradural haematoma due to head injury.

Why: e.g. amphetamine, marijuana, cocaine, LSD, PCP.

Why: may determine risk of HIV and syphilis infection which may cause cognitive impairment.

Why: e.g. carbon monoxide, chronic barbiturate intoxication, heavy metals such as mercury and manganese.

Why: may suggest attention deficit hyperactivity disorder.

Why: e.g. poor eye contact, aloneness, difficulties relating to peers - may suggest autism as cause of cognitive impairment.

Why: e.g. if not walking by 18 months consider Duchenne muscular dystrophy.

Why: Depression may exhibit many of the features of an early dementia, especially memory impairment, slowed thinking and lack of spontaneity.

Why: can suggest any infection that may cause delirium or meningitis, encephalitis, brain abscess or brain hemorrhage.

Why: e.g. limb weakness or paralysis, facial muscle weakness or paralysis, difficulty with speech and swallow.

Why: may suggest brain cancer or acute stroke.

Why: e.g. delusions, hallucinations and disordered thinking - may suggest schizophrenia or bipolar disorder.