Assessment and diagnosis of dementia : a review for primary healthcare professionals

Abstract

Dementia is one of the most costly, disabling diseases associated with ageing, yet it remains underdiagnosed in primary care. In this article, we present the comprehensive approach illustrated with a classical case for diagnosing dementia which can be applied by healthcare professionals in primary care. This diagnostic approach includes history taking and physical examination, cognitive testing, informant interviews, neuropsychological testing, neuroimaging, and the utility of cerebrospinal fluid biomarkers. For the differential diagnosis of cognitive impairment, the differences and similarities among normal ageing, mild cognitive impairment, depression, and delirium are highlighted. As primary care physicians are playing an increasingly prominent role in the caring of elderly patients in an ageing population, their role in the diagnosis of dementia should be strengthened in order to provide a quality care for patients with dementia. 在老年社會中，認知障礙症是引致經濟負擔和令患者失去自理能力的最嚴重的疾病之一，但在社區中，患者往往未得到充分診斷。本文回顧診斷認知障礙症的最新方法，並解說醫療專業人員如何在基礎醫療中應用。透過審視病例，本文闡述的診斷方法包括病史和臨床體檢、認知評估、家人和照顧者訪談、神經心理學測試、神經影像學和腦脊液中的標誌物。為了幫助鑑別診斷認知障礙，本文比較正常衰老、輕度認知障礙、抑鬱和譫妄症間的差異和相似性。為了讓老年患者社區中得到適切的診斷和治療，基礎醫療在診斷認知障礙症中的角色應予以加強。