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 Finding the Medical Causes of "Dementia" in the Elderly: the Genesis Protocols

Used by the Los Angeles County Genesis Program

Their phone number is (213) 351-7284   

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These protocols were provided by nurse Barbara Massey working in the Genesis Program under the Los Angeles County Department of Mental Health. The Genesis Program has been around since about 1995. It is a community outreach effort that helps organize assistance for seniors who cannot care for themselves. They are primarily called in to handle people with "dementia."

The remarkable thing is that somewhere along the line the staff of the program started questioning cases of alleged "dementia" and started getting people physically examined for causes. Now they no longer accept it as a diagnosis. They now insist on finding the causes. Barbara said they find the cause in 75-80% of cases and she estimates that 98% of the cases they see have medically-induced dementia (not Alzheimer's). This includes sudden memory loss, delusions, etc.

Basic Recommendations for Handling "Dementia":

Nurse Massey said about 70% or more of the cases are caused by the following, by themselves or in combination with other ailments.

Hypothyroidism. 
B12 deficiency. 
General poor nutrition. 
Urinary tract infection. 
Subdural hematoma (ask about recent falls and head injuries) 
Mixing the wrong meds or contra-indicated herbs and meds (or even too many different herbs) or wrong doses. They physically go to the house and look at what the person takes and ask. She reported one case of a women taking a brand name drug and a generic form, apparently thinking they were two different drugs. 

Recommended Standard Protocols for Exam:

Vital signs including orthostatics, weight, etc. 
Hearing and vision evaluation (can pick up "hallucination" sources) 
Nutrition and hydration. 
Neurological exam (CN II-XII, sensory motor reflexes, gait). She mentioned that a pronounced change in gait commonly indicated rapidly declining health approaching in the elderly. 
Full physical exam. 
Poly-pharmacy evaluation (All their drugs and doses) 

Tests:

Labs: CBC, Electrolytes, BUN Creatine, Blood sugars, Calcium, Phosphorus, B12, Folate, RPR, LFT, TSH 
Urinalysis. 
EKG (lack of oxygen can lead to poor mental function.) 
Chest X-Ray, Pulse-Oximetry, Arterial blood gas if needed. 
Head CT/MRI/ SPECT. (They originally had this as optional for special situations but now feel it should be standard.) 

For Special Patients Consider:

PT/PTT 
Lumbar puncture 
HIV 
Ammonia 
Cultures. 
Drug Screen (Alcohol, narcotics, benzodiazapenes) 
Medication levels as appropriate 
Mammography, PSA, Occult blood. 

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