Suspect dementia, pseudodementia. Also factor in other disorders that could cause memory problems such as a folate or B-12 deficiency (ever hear of the classic tea and toast question on the USMLE?).
Tests? The MMSE can be done, although there are better tests out there such as the MOCA and the Addenbrooke's.
http://www.stvincents.ie/dynamic/File/Addenbrookes_A_SVUH_MedEl_tool.pdf
The problem with the Addenbrooke, is most of the formats I've seen are UK specific. E.g. when it asks the patient to memorize an address, it's a UK style address.
Harry Barnes
73 Orchard Close
Kingsbridge
Devon
My PD made a specific one for a US patient, but I don't have the file on me at the moment, though you could substitute one on your own. E.g.
Jerry Brown
85 Washburn Avenue
Louisville
Kentucky
An added advantage of the Addenbrooke is that is has the MMSE incorporated into it. So no one can accuse you of not doing an MMSE which is standard of care, but considered a poor test to screen for dementia.
Do a typical dementia work-up, while trying to rule out pseudodementia. The work-up will be in any of your major texts.
Aside from the direct medical concerns of dementia, you want to assess the person's function if possible. For legal purposes, I was told to refer to a neurologist and look up the local laws concerning the person's driving ability. In dementia, several doctors do not take precautions to prevent their patients from driving. A demented person may likely not be able to drive, or will not be able to drive in a few weeks to months. In NJ, I was advised to refer the patient to a neurologist and have them sort it out, though it may differ by state.
Several entities such as the APA have issued guidelines that psychiatrists should not be in the business of determining if a patient can or cannot drive. No where in our training did we gain expertise in that area. Do not claim to be an expert in the area, or give a final stamp of approval on a patient's safety to drive without getting some very clear guidelines in print saying you can do so.
In an inpatient setting an occupational therapist can assess the patient's ADL status, and make recommendations as to whether or not the person can care for them-self, or is in need of assisted living. In an outpatient setting the patient can be assessed by an OT by referral.
