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Diagnostic Tests in the Evaluation of Dementia: A Prospective Study of 200 Elderly Outpatients

Diagnostic Tests in the Evaluation of Dementia: A Prospective Study of 200 Elderly Outpatients Abstract • We studied the components of the diagnostic evaluation in 200 patients older than 60 years of age with suspected dementia who received standardized diagnostic evaluation and follow-up. The most common dementia diagnoses were Alzheimer's-type dementia (74.5%) and dementia due to toxic effects of drugs (9.5%). Eleven patients with hypothyroidism, metabolic encephalopathies due to hyponatremia, hyperparathyroidism, and hypoglycemia required laboratory tests for diagnosis, whereas the other dementia diagnoses were made primarily on the basis of data available on the history and physical and neurologic examinations. The complete blood cell count, blood chemistry battery (especially sodium, calcium, and glucose concentrations), and thyroid function tests were of definite value for the diagnosis of unsuspected disease and were useful as routine tests in evaluating patients for dementia. A careful history and physical examination accompanied by complete blood cell count, chemistry battery, and a thyroid function test would have been effective in diagnosing treatable illnesses causing cognitive impairment. Other diagnostic tests could have been used selectively based on results of the examination and screening tests. Estimated diagnostic charges from a selective approach would be 25% to 34% of those for the "routine" evaluation. (Arch Intern Med 1986;146:1917-1922) References 1. National Institute on Aging Task Force: Senility reconsidered: Treatment possibilities for mental impairment in the elderly. JAMA 1980;244: 259-263.Crossref 2. Beck JC: Dementia in the elderly: The silent epidemic. Ann Intern Med 1982;97:231-241.Crossref 3. Marsden CD, Harrison MJG: Outcome of investigations in patients with presenile dementia. Br Med J 1972;2:249-252.Crossref 4. Smith JS, Kiloh LG: The investigation of dementia: Results of 200 consecutive admissions. Lancet 1981;1:824-827.Crossref 5. Freeman FR: Evaluation of patients with progressive intellectual deterioration. Arch Neurol 1976;37:658-659.Crossref 6. Fox JH, Topel JL, Huckman MS: Dementia in the elderly: A search for treatable illness. J Gerontol 1975;34:557-564.Crossref 7. Larson EB, Reifler BV, Featherstone HJ, et al: Dementia in elderly outpatients: A prospective study. Ann Intern Med 1984;100:417-423.Crossref 8. Larson EB, Reifler BV, Sumi SM, et al: Diagnostic evaluation of 200 elderly outpatients with suspected dementia. J Gerontol 1985;40:536-543.Crossref 9. Lau KS, Gottlieb C, Wasserman L, et al: Measurement of serum vitamin B12 using radioisotope dilution and coated charcoal. Blood 1965;26: 202-214. 10. Herbert V: Aseptic addition method for Lactobacillus casei assay of folate activity in human serum. J Clin Pathol 1966;19:12-19.Crossref 11. Eisdorfer C, Cohen D: Diagnostic criteria for primary neuronal degeneration of Alzheimer's type. J Fam Pract 1980;4:553-557. 12. Rumke L: Uncertainty as to the acceptance or rejection of the presence of an effect in relation to the number of observations in an experiment. Triangle 1968;8:284-289. 13. Read AE, Gough KR, Pardac JL, et al: Nutritional studies on the entrants to an old people's home with particular reference to folic acid deficiency. Br Med J 1965;11:843-848.Crossref 14. Rosenberg IH, Bowman BB, Cooper BA, et al: Folate nutrition in the elderly. Am J Clin Nutr 1982;36:1060-1066. 15. Garry PJ, Goodwin JS, Hunt WC: Folate and vitamin B12 status in a healthy elderly population. J Am Geriatr Soc 1984;32:719-726. 16. Rodriquez MS: A conspectus of research on folacin requirements of man. J Nutr 1978;108:1983-2103. 17. Goodwin JS, Goodwin JM, Garry PJ: Association between nutritional status and cognitive functioning in a healthy elderly population. JAMA 1983;249:2917-2920.Crossref 18. Goldie PJ, Jones SR, Thomas MJ: A reappraisal of the free thyroxine index. Lancet 1981;2:572-573.Crossref 19. Caldwell G, Kelletl HA, Gow SM, et al: A new strategy for thyroid function testing. Lancet 1985;1:1117-1120.Crossref 20. David PJ, Davis FB: Hyperthyroidism in patients over the age of 60 years: Clinical features in 85 patients. Medicine 1974;53:161-181. 21. Benson PF: Diagnostic techniques in dementia. Ann Intern Med 1982;97:238-239. 22. Dietch JT: Computerized tomographic scanning in cases of dementia. West J Med 1983;138:835-837. 23. Bradshaw JR, Thomson JL, Campbell MJ: Computed tomography in the investigation of dementia. Br Med J Clin Res 1983;286:277-280.Crossref 24. Gado M, Hughes CP, Danziger W, et al: Aging, dementia, and brain atrophy: A longitudinal computer tomographic study. Am J Neuroradiol 1983;4:699-702. 25. Wells CE, Duncan GW: Danger of overreliance on computerized cranial tomography. Am J Psychiatry 1977;134:811-813. 26. Wu S, Schenkenberg T, Wing SD, et al: Cognitive correlates of diffuse cerebral atrophy determined by computed tomography. Neurology 1981;31: 1180-1184.Crossref 27. Yerby MS, Sundsten J, Larson EB, et al: A new method of measuring brain atrophy: The effect of aging in its application for diagnosing dementia. Neurology 1985;35:1316-1320.Crossref 28. Williamson J, Stokoe IH, Gray S, et al: Old people at home: Their unreported needs. Lancet 1964;1:1117-1120.Crossref 29. Korvin CC, Pearce RH, Stanley J: Admissions screening: Clinical benefits. Ann Intern Med 1975;83:197-203.Crossref 30. Leonard JV, Clayton BE, Colley JR: Use of biochemical profile in children's hospital: Results of two controlled trials. Br Med J 1975;2:662-665.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Diagnostic Tests in the Evaluation of Dementia: A Prospective Study of 200 Elderly Outpatients

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References (32)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360220061012
Publisher site
See Article on Publisher Site

Abstract

Abstract • We studied the components of the diagnostic evaluation in 200 patients older than 60 years of age with suspected dementia who received standardized diagnostic evaluation and follow-up. The most common dementia diagnoses were Alzheimer's-type dementia (74.5%) and dementia due to toxic effects of drugs (9.5%). Eleven patients with hypothyroidism, metabolic encephalopathies due to hyponatremia, hyperparathyroidism, and hypoglycemia required laboratory tests for diagnosis, whereas the other dementia diagnoses were made primarily on the basis of data available on the history and physical and neurologic examinations. The complete blood cell count, blood chemistry battery (especially sodium, calcium, and glucose concentrations), and thyroid function tests were of definite value for the diagnosis of unsuspected disease and were useful as routine tests in evaluating patients for dementia. A careful history and physical examination accompanied by complete blood cell count, chemistry battery, and a thyroid function test would have been effective in diagnosing treatable illnesses causing cognitive impairment. Other diagnostic tests could have been used selectively based on results of the examination and screening tests. Estimated diagnostic charges from a selective approach would be 25% to 34% of those for the "routine" evaluation. (Arch Intern Med 1986;146:1917-1922) References 1. National Institute on Aging Task Force: Senility reconsidered: Treatment possibilities for mental impairment in the elderly. JAMA 1980;244: 259-263.Crossref 2. Beck JC: Dementia in the elderly: The silent epidemic. Ann Intern Med 1982;97:231-241.Crossref 3. Marsden CD, Harrison MJG: Outcome of investigations in patients with presenile dementia. Br Med J 1972;2:249-252.Crossref 4. Smith JS, Kiloh LG: The investigation of dementia: Results of 200 consecutive admissions. Lancet 1981;1:824-827.Crossref 5. Freeman FR: Evaluation of patients with progressive intellectual deterioration. Arch Neurol 1976;37:658-659.Crossref 6. Fox JH, Topel JL, Huckman MS: Dementia in the elderly: A search for treatable illness. J Gerontol 1975;34:557-564.Crossref 7. Larson EB, Reifler BV, Featherstone HJ, et al: Dementia in elderly outpatients: A prospective study. Ann Intern Med 1984;100:417-423.Crossref 8. Larson EB, Reifler BV, Sumi SM, et al: Diagnostic evaluation of 200 elderly outpatients with suspected dementia. J Gerontol 1985;40:536-543.Crossref 9. Lau KS, Gottlieb C, Wasserman L, et al: Measurement of serum vitamin B12 using radioisotope dilution and coated charcoal. Blood 1965;26: 202-214. 10. Herbert V: Aseptic addition method for Lactobacillus casei assay of folate activity in human serum. J Clin Pathol 1966;19:12-19.Crossref 11. Eisdorfer C, Cohen D: Diagnostic criteria for primary neuronal degeneration of Alzheimer's type. J Fam Pract 1980;4:553-557. 12. Rumke L: Uncertainty as to the acceptance or rejection of the presence of an effect in relation to the number of observations in an experiment. Triangle 1968;8:284-289. 13. Read AE, Gough KR, Pardac JL, et al: Nutritional studies on the entrants to an old people's home with particular reference to folic acid deficiency. Br Med J 1965;11:843-848.Crossref 14. Rosenberg IH, Bowman BB, Cooper BA, et al: Folate nutrition in the elderly. Am J Clin Nutr 1982;36:1060-1066. 15. Garry PJ, Goodwin JS, Hunt WC: Folate and vitamin B12 status in a healthy elderly population. J Am Geriatr Soc 1984;32:719-726. 16. Rodriquez MS: A conspectus of research on folacin requirements of man. J Nutr 1978;108:1983-2103. 17. Goodwin JS, Goodwin JM, Garry PJ: Association between nutritional status and cognitive functioning in a healthy elderly population. JAMA 1983;249:2917-2920.Crossref 18. Goldie PJ, Jones SR, Thomas MJ: A reappraisal of the free thyroxine index. Lancet 1981;2:572-573.Crossref 19. Caldwell G, Kelletl HA, Gow SM, et al: A new strategy for thyroid function testing. Lancet 1985;1:1117-1120.Crossref 20. David PJ, Davis FB: Hyperthyroidism in patients over the age of 60 years: Clinical features in 85 patients. Medicine 1974;53:161-181. 21. Benson PF: Diagnostic techniques in dementia. Ann Intern Med 1982;97:238-239. 22. Dietch JT: Computerized tomographic scanning in cases of dementia. West J Med 1983;138:835-837. 23. Bradshaw JR, Thomson JL, Campbell MJ: Computed tomography in the investigation of dementia. Br Med J Clin Res 1983;286:277-280.Crossref 24. Gado M, Hughes CP, Danziger W, et al: Aging, dementia, and brain atrophy: A longitudinal computer tomographic study. Am J Neuroradiol 1983;4:699-702. 25. Wells CE, Duncan GW: Danger of overreliance on computerized cranial tomography. Am J Psychiatry 1977;134:811-813. 26. Wu S, Schenkenberg T, Wing SD, et al: Cognitive correlates of diffuse cerebral atrophy determined by computed tomography. Neurology 1981;31: 1180-1184.Crossref 27. Yerby MS, Sundsten J, Larson EB, et al: A new method of measuring brain atrophy: The effect of aging in its application for diagnosing dementia. Neurology 1985;35:1316-1320.Crossref 28. Williamson J, Stokoe IH, Gray S, et al: Old people at home: Their unreported needs. Lancet 1964;1:1117-1120.Crossref 29. Korvin CC, Pearce RH, Stanley J: Admissions screening: Clinical benefits. Ann Intern Med 1975;83:197-203.Crossref 30. Leonard JV, Clayton BE, Colley JR: Use of biochemical profile in children's hospital: Results of two controlled trials. Br Med J 1975;2:662-665.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1986

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