Focus of the workup: To exclude reversible causes.
(Assumes a basic infectious workup already performed or not relevant.)
Most common reversible causes: Depression, worsening deafness, and oversedation from prescription meds or EtOH.
[ ] Review all meds, all substance use
[ ] Depression?
[ ] Hearing? Arrange formal audiometry
[ ] Asterixis? Indicates metabolic encephalopathy
[ ] Kayser-Fleischer ring? (brown rim around iris seen in Wilson's disease)
[ ] Head CT (for SDH, tumor, NPH)
[ ] Thiamine B-1 (for Wernicke-Korsakoff)
[ ] B-12
[ ] PTH, Ca++ (for hyperparathyroidism)
[ ] TSH Free T4 (for hypothyroidism)
[ ] LFTs, ammonia (for hepatic encephalopathy)
+/- ceruloplasmin if c/f Wilson's
[ ] Chem 7 (for uremic encephalopathy)
[ ] HIV
[ ] RPR (syphyllis)