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

doi:10.1001/archinte.1986.00360220061012

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Vol. 146 No. 10, October 1986

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Diagnostic Tests in the Evaluation of Dementia

A Prospective Study of 200 Elderly Outpatients

Eric B. Larson, MD, MPH; Burton V. Reifler, MD, MPH; Shuzo M. Sumi, MD; Connie G. Canfield, RN; Nina M. Chinn, RN

Arch Intern Med. 1986;146(10):1917-1922.

Abstract

• We studied the components of the diagnostic evaluationin 200 patients older than 60 years of age with suspected dementiawho 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%). Elevenpatients with hypothyroidism, metabolic encephalopathies dueto hyponatremia, hyperparathyroidism, and hypoglycemia requiredlaboratory tests for diagnosis, whereas the other dementia diagnoseswere made primarily on the basis of data available on the historyand physical and neurologic examinations. The complete bloodcell count, blood chemistry battery (especially sodium, calcium,and glucose concentrations), and thyroid function tests wereof definite value for the diagnosis of unsuspected disease andwere useful as routine tests in evaluating patients for dementia.A careful history and physical examination accompanied by completeblood cell count, chemistry battery, and a thyroid functiontest would have been effective in diagnosing treatable illnessescausing cognitive impairment. Other diagnostic tests could havebeen used selectively based on results of the examination andscreening tests. Estimated diagnostic charges from a selectiveapproach would be 25% to 34% of those for the "routine" evaluation.

(Arch Intern Med 1986;146:1917-1922)

Author Affiliations

From the Departments of Medicine (Dr Larson and Mss Canfield and Chinn), Psychiatry (Dr Reifler), Neurology (Dr Sumi), and Neuropathology (Dr Sumi), University of Washington School of Medicine, Seattle. Dr Larson is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Footnotes

Accepted for publication Jan 2, 1986.

Read in part before the National Meeting of the American Federationfor Clinical Research, Washington, DC, May 5, 1984.

Reprint requests to Department of Medicine RG-20, Universityof Washington, Seattle, WA 98195 (Dr Larson).

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