How to avoid 3 common errors in dementia screening

TABLE 4
Trail Making: Outdated norms vs current norms

^{COWAT, Controlled Oral Word Association Task; MMSE, Mini-Mental State Examination.}

Patients deserve an accurate assessment


A diagnosis of dementia profoundly affects patients and families. Progressive dementia such as Alzheimer’s disease means an individual will spend the rest of his or her life (usually 8-10 years) with decreasing cognitive capacity and quality of life.^33-35 It also means families will spend years providing or arranging for care, and watching their family member deteriorate. Early detection can afford affected individuals and families the opportunity to make plans for fulfilling wishes and dreams before increased impairment makes such plans unattainable. The importance of rigor in assessment is therefore essential.

Even seemingly minor deviations in screening test procedures can contaminate results as surely as using nonsterile containers in biologic testing.

Optimizing accuracy in screening for dementia also can enable physicians to reasonably reassure patients that they likely do not suffer from a dementia at the present time, or to at least recommend that they be further assessed by a specialist. Without rigor, time and resources are wasted and the important question that triggered the referral is neither satisfactorily—nor accurately—addressed. Thus, there is a need to use not just simple cutoff scores but to apply the most current age and education normative data, and adhere to administrative instructions verbatim.

CORRESPONDENCE
Lindy A. Kilik, PhD, Geriatric Psychiatry Program, Providence Care Mental Health Services, PO Bag 603, Kingston, Ontario, Canada K7L 4X3; kilikl@queensu.ca