Evaluation of suspected dementia

Drexel University College of Medicine, Philadelphia, PA 19127, USA.
American family physician (Impact Factor: 2.18). 10/2011; 84(8):895-902.
Source: PubMed


As the proportion of persons in the United States older than 65 years increases, the prevalence of dementia will increase as well. Risk factors for dementia include age, family history of dementia, apolipoprotein E4 genotype, cardiovascular comorbidities, chronic anticholinergic use, and lower educational level. Patient history, physical examination, functional assessment, cognitive testing, laboratory studies, and imaging studies are used to assess a patient with suspected dementia. A two-visit approach is time-effective for primary care physicians in a busy outpatient setting. During the first visit, the physician should administer a screening test such as the verbal fluency test, the Mini-Cognitive Assessment Instrument, or the Sweet 16. These tests have high sensitivity and specificity for detecting dementia, and can be completed in as little as 60 seconds. If the screening test result is abnormal or clinical suspicion of another disease is present, appropriate laboratory and imaging tests should be ordered, and the patient should return for additional cognitive testing. A second visit should include a Mini-Mental State Examination, Geriatric Depression Scale, and verbal fluency and clock drawing tests, if not previously completed.

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    • "Despite the availability of pharmaceutical and life-style interventions that show some benefit in the treatment of dementia [7,8,39-41], there is no cure. Results from the literature indicate that most older adults would accept screening for dementia [37,42], yet few primary care physicians conduct dementia screening, and as many as 50% of PCPs are unaware of their older patients’ cognitive status [43,44]. While the United States Preventive Services Task Force has determined that the need for screening non-symptomatic patients for dementia in primary care is unsubstantiated, the Center for Medicare and Medicaid Services and expert recommendations on the comprehensive care of older adults encourage early detection of dementia [6,9,4]. "
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