Dementia, Secondary Causes Panel

Test Code

91410

CPT Codes
80053, 82607, 82746, 84443, 85025

Includes

Comprehensive Metabolic Panel
CBC (includes Differential and Platelets)
TSH
Vitamin B12 (Cobalamin)
Folate

Preferred Specimen

Whole blood from a full EDTA (lavender-top) tube and
3 mL serum red-top tube (no gel) and
2 mL serum collected in a serum separator tube (SST®)

Patient Preparation
Fasting specimen is preferred.

Specimen collection after fluorescein dye angiography should be delayed for at least 3 days. For patients on hemodialysis, specimen collection should be delayed for 2 weeks. According to the assay manufacturer Siemens: "Samples containing fluorescein can produce falsely depressed values when tested with the Advia Centaur TSH3 Ultra assay."

Minimum Volume

Whole blood: 1 mL and
Serum: 1.7 mL and
Serum (SST only): 1 mL

Other Acceptable Specimens

Whole blood from a full EDTA (tan-top) tube

Instructions

See individual assays.
EDTA: Maintain specimen at room temperature. Do not refrigerate. If multiple draw, collect EDTA (lavender-top) tube last. Traumatic draw can introduce thromboplastin and trap WBC and platelets. Refrigeration can precipitate fibrin and trap WBC and platelets.

Serum note: If transport to performing laboratory will exceed 24 hours please transport refrigerated (cold packs).

Note: If drawn with lead testing, EDTA (tan-top) is required.

Transport Temperature

Whole Blood: Room temperature
Serum: Refrigerated (cold packs)

Specimen Stability

Whole blood
Room temperature: 48 hours
Refrigerated: 48 hours
Frozen: Unacceptable

Serum (SST only)
Room temperature: 72 hours
Refrigerated: 72 hours
Frozen: Unacceptable

Serum
Room temperature: 36 hours
Refrigerated: 7 days
Frozen: 28 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

See individual assays

Methodology
See individual tests

Setup Schedule

Set up: Mon-Fri; Report Available: 3-6 days

Clinical Significance

This panel is designed to evaluate a patient for the presence of potentially reversible (i.e., secondary) causes of dementia such as Vitamin B12 deficiency, hypothyroidism, hypoparathyroidism, anemia, hypoxia or hypercapnia, hepatic and renal encephalopathies, diabetes, and dehydration.
The panel includes a Complete Blood Count, TSH, Vitamin B12, Folate, and a Comprehensive Metabolic Panel. It is modeled after the recommendations of the American Academy of Neurology (AAN), a National Institutes of Health Consensus Panel, the European Federation of Neurological Societies (EFNS), and others [1-4].

References
1. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1143-1153.
2. Consensus conference. Differential diagnosis of dementing diseases. JAMA. 1987;258:3411-3416.
3. Sorbi S, Hort J, Erkinjuntti T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19:1159-1179.
4. Simmons BB, Hartmann B, DeJoseph D. Evaluation of suspected dementia. Am Fam Physician. 2011;84:895-902.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.