Abstract
As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia.
Highlights
Increased recognition of a prolonged pre-dementia phase in neurocognitive conditions such as Alzheimer’s disease (AD) has led to interest in defining diagnostic definitions and biomarkers to allow for earlier recognition and intervention to prevent or postpone dementia
It has become apparent that certain subtypes may be linked to specific dementia etiologies. Those with amnestic mild cognitive impairment (aMCI) are more likely to progress to AD; this has been further validated by the presence of biomarkers assumed to be associated with AD, such as changes in MRI, FDG-Positron emission tomography (PET) and PiB PET [16]
The routine use of SPECT imaging is not recommended, as a normal SPECT does not exclude AD [42] and has little value over a standard comprehensive clinical assessment when trying to differentiate Mild cognitive impairment (MCI) from dementia
Summary
Increased recognition of a prolonged pre-dementia phase in neurocognitive conditions such as Alzheimer’s disease (AD) has led to interest in defining diagnostic definitions and biomarkers to allow for earlier recognition and intervention to prevent or postpone dementia. There are currently no specific treatments to block the progression of cognitive decline in AD and other neurocognitive dementias, there are important reasons from a patient’s social and personal perspective that an early diagnosis is important. Dementia screening by a primary care physician should be completed as soon as possible once a patient or a knowledgeable informant has noticed decline in memory or difficulty in performing day-to-day tasks such as paying bills, shopping or managing medications as this enables opportunities for counseling for future care and a chance to arrange financial and legal matters while decision-making capacity remains. There is a risk of misdiagnosis of a range of behaviors as dementia, resulting in under-treatment and misdirection of patients to inappropriate services, especially in a multicultural setting where English might not be the primary. It should be up to the patient to decide the amount of information they should receive
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