1. **History & Examination** - Ask about chronic cough, sputum, wheeze, dyspnea on exertion. - Inquire about occupational/industrial exposures. - Look for signs of hyperinflation, barrel chest, and reduced breath sounds.
2. **Pulmonary Function Tests (PFT)** - If available, obtain spirometry. Look for: - Reduced FEV₁/FVC ratio (<70% predicted). - Non‑reversible obstruction (little change after bronchodilator).
3. **Imaging** - If chest X‑ray shows emphysema‑like changes or air trapping, consider further imaging. - Consider high‑resolution CT if diagnosis remains uncertain.
4. **Laboratory Tests** - Routine CBC, BMP to assess for anemia or electrolyte disturbances that could affect cognition.
5. **Medication Review** - Identify drugs with anticholinergic properties (e.g., certain antihistamines, tricyclic antidepressants, opioids) and consider deprescribing if appropriate.
6. **Functional Assessment** - Evaluate activities of daily living; determine whether the patient requires assistance or supervision. - Use cognitive screening tools (MMSE, MoCA) to quantify deficits.
7. **Safety Measures** - Ensure safe environment: remove hazards, install grab bars, improve lighting. - Provide supervision during activities that require concentration or coordination.
8. **Follow‑up and Reassessment** - Monitor changes in cognition and daily functioning after interventions. - Adjust care plan accordingly; involve multidisciplinary team if needed (nephrologist, geriatrician, occupational therapist).
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### Key Take‑away
- **Cognitive impairment in CKD is common and multifactorial.** - **Management focuses on correcting reversible factors, optimizing dialysis, providing supportive care, and ensuring safety in daily activities.** - **A systematic assessment of cognition and functional status should guide individualized interventions to maintain independence and quality of life for patients with CKD.**
