Splaine Consulting

Thinking About Thinking™: How to help a patient with a thinking problem using KAER

mikesplaineBy Michael Splaine, Principal, Splaine Consulting

The scenarios are endless, so let’s narrow this down to an office visit. Perhaps you have implemented the annual wellness visit and a patient scores poorly on the simple cognitive test.  Or a concerned daughter-in-law tips you off that mom isn’t as sharp as she was. Or the patient mentions changes in his or her thinking (least likely).

There are things to be done, especially in primary practice, without immediately assuming the worst (irreversible dementia) — or sending someone off to likely wait for a specialist consult.   

A new resource called KAER could guide your approach. Developed by a blue-ribbon expert panel convened by the Gerontological Society of America that included several practitioner associations, it suggests four steps and provides options for routines that you can build into practice.


  • Kickstart the conversation.

  • Assess for cognitive impairment.

  • Evaluate.

  • Refer to community resources.


Worth noting: The workgroup identified six sets of recommended components of a diagnostic evaluation for dementia. All members endorsed a central role for PCPs in diagnosing dementia in older adults, and agreed that most of what needs to be done in evaluating a patient for dementia can be done or coordinated through primary care.

These steps include:

  1. blood tests,
  2. a drug review,
  3. gathering information about the onset, course and nature of memory and other cognitive impairments, and
  4. gathering information about any associated behavioral, medical, or psychological issues, including co-morbid medical conditions, alcohol and other substance use, vision and hearing problems, and depression.

Stay tuned to this site and our social media networks for the next post in this new series.

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