AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 72-year-old female is brought to the clinic by her daughter due to concerns about her mother's progressive memory loss, difficulty with executive functions (e.g., managing finances), and occasional disorientation over the past year. The patient has a history of hypertension and well-controlled type 2 diabetes. She denies depression or recent head trauma. Which of the following is the most appropriate initial diagnostic step in her workup for dementia?
- APositron emission tomography (PET) scan of the brain
- BGenetic testing for APOE ε4 allele
- CCerebrospinal fluid (CSF) analysis for amyloid-beta and tau proteins
- DComprehensive cognitive assessment and laboratory screening
Show answer & explanationAnswer & explanation
Correct answer: D. Comprehensive cognitive assessment and laboratory screening
The initial workup for suspected dementia involves a comprehensive cognitive assessment to characterize the deficits, combined with laboratory screening to rule out reversible causes. This includes blood tests for thyroid function, vitamin B12, syphilis, and a complete blood count, as well as a metabolic panel.
Why the other options are wrong
- A. PET scans are advanced neuroimaging techniques used later in the diagnostic process if the diagnosis remains unclear after initial workup and structural imaging.
- B. Genetic testing for APOE ε4 allele is a risk factor for Alzheimer's but is not used for routine diagnostic purposes due to its limited predictive value and ethical considerations.
- C. CSF analysis for biomarkers is typically reserved for more complex cases or research, not initial screening.
Dementia Initial Workup
The first steps in evaluating a patient with suspected cognitive decline to establish a diagnosis and identify reversible causes.
- Includes comprehensive history and physical exam.
- Cognitive assessment is essential.
- Laboratory tests rule out treatable conditions.
Memory trick: For Dementia, 'C'ognitive 'A'ssessment and 'L'abs 'S'tart.