Virginia Research Day 2021

Medical Resident Research Case Reports

12 Utility of Neuroimaging in Patients with Chronic Cognitive Impairment

Charlotte Patel, DO; Elliot Freed, DO Corresponding author: charlotte.wertz@hcahealthcare.com

LewisGale Physicians-Giles Family Medicine Lewis Gale Hospital-Montgomery

Introduction: Primary care physicians commonly see patients with complaints of cognitive impairment and functional decline. Neuroimaging is unequivocally indicated in patients with acute onset of such symptoms; however, the use of imaging in the evaluation of patients with more progressive symptom onset is controversial. This case highlights the importance of neuroimaging in patients with known dementia who exhibit an acute change in their cognitive/functional status. Case Presentation: An 82-year-old male with past medical history significant for dementia, depression, and hypothyroidism presented for his annual Medicare wellness visit. He was accompanied by his wife and daughter, who expressed concerns about an abrupt decline in his functional status 2-3 weeks earlier. More progressive symptoms of cognitive decline improved with the addition of memantine 3

months prior. This patient’s cognitive and physical impairments were previously well-controlled for many years with donepezil, sertraline, and levothyroxine. At the time of his annual wellness visit, recent lab results were reviewed, his levothyroxine dose was increased accordingly, head CT was ordered, and the patient was referred to physical therapy. Ultimately, the patient was found to have a brain lesion consistent with a glioblastoma. He was promptly referred to oncology, where treatment options were discussed with the patient and his family. They chose to forego additional work up and enroll in hospice/palliative care. The patient passed away less than 3 weeks later. Discussion: This case highlights the utility of neuroimaging in all patients who present with acute cognitive impairment or functional decline. It is critical that medical professionals, especially primary care

providers, remain diligent in their assessment for treatable causes of such symptoms and not simply attribute them to known dementia or other chronic conditions. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

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