Dementia Screening and Surveillance: Are There Opportunities for Early Detection?

The prevalence of dementia, and in particular Alzheimer's disease, is expected to increase dramatically in the elderly population over the next few decades. Because of the possibilities of pharmacological and psychosocial interventions, which aim to slow down or even prevent progress of the disease, early detection of dementia is of the utmost importance. The screening of patients at risk is the first step in the detection of dementia and should be undertaken at the primary healthcare level. A history and mental state examination is necessary for all patients, and in particular for elderly patients, who have had cognitive complaints and/or reports of cognitive decline. Useful screening tests for dementia are either the Mini-Mental State Examination (MMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); an MMSE score <27 and an IQCODE score >3.31 indicate a possible dementia and should be further investigated. However, neither MMSE nor IQCODE should be used as a diagnostic tool. Because of the heterogeneity of the deficits and the absence of a biological marker, the diagnosis of early degenerative dementias can be very complex and requires a multidisciplinary approach. Basic routine investigations carried out at the general practitioner (GP) level include physical and neurological examinations, a laboratory screen and a computerised tomography or magnetic resonance imaging examination. A neuropsychological examination is necessary to establish the diagnosis and there is promising evidence for the predictive value of some specific tests for Alzheimer's disease. Complementary investigations such as functional neuroimaging, electroencephalogram and CSF investigations, may be indicated in some cases. Efficient management programmes can only be effective if they are implemented as early as possible and adapted regularly to the changing needs of patients with dementia and their caregivers. The creation of health teams working in the community under the supervision of a GP seems to be a promising model for the care of the patient with dementia living in the community.