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Screening tests for dementia

Published online by Cambridge University Press:  02 January 2018

Balamurugan Ganesan*
Affiliation:
ST6 in Old Age Psychiatry, Erewash Older Adults CMHT Ilkeston Resource Centre, Derbyshire. Email: balamurgan.ganesan@derbysmhservices.nhs.uk
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Abstract

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © The Royal College of Psychiatrists, 2010

Only a tiny proportion of the laboratory and radiology tests identify potentially reversible causes of dementia. Reference Foy, Okpalugo and Leonard1 However, I would like to sound a note of caution against reducing the use of blood investigations like vitamin B12, folate and thyroid function tests in practice.

In the largest study in terms of sample size Reference Hejl, H⊘gh and Waldemar2 the authors found that although a potentially reversible cause was found in only 4% of people with dementia overall, it rose to 19% when limited to people with a young-onset dementia. They also showed that concomitant conditions that were reversible, like vitamin B12 deficiency and thyroid deficiency, were more frequent in patients with mild cognitive deficits than in those meeting the criteria for dementia. Although treatment of these conditions may not always lead to complete resolution of cognitive symptoms, it is important to identify any concomitant conditions in this group to prevent a misdiagnosis of dementia. The recent national dementia strategy 3 has also placed a strong emphasis on specialist assessment and accurate diagnosis.

I agree that subjecting a frail older person in their 90s with a clear history of insidious onset and gradually progressive memory loss to all the battery of investigations may be unwise, but I feel that these investigations should remain an intrinsic part of a comprehensive assessment of someone presenting with a mild cognitive impairment in their 70s or earlier.

References

1 Foy, K, Okpalugo, C, Leonard, F. Usefulness of routine blood tests in dementia work-up [letter]. Psychiatr Bull 2009; 33: 481.Google Scholar
2 Hejl, A, H⊘gh, P, Waldemar, G. Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neurol Neurosurg Psychiatry 2002; 73: 390–4.Google Scholar
3 Department of Health. Living Well with Dementia: A National Dementia Strategy. Department of Health, 2009.Google Scholar
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