Diagnosis

Diagnosis is made on clinical grounds from the history and mental state examination including simple cognitive testing.

In taking the history, if there is a suspicion of dementia, it will be appropriate to do cognitive testing early in the interview. This will give guidance as to whether the patient can give a proper history or not (so as not to spend too much time, and annoy the patient, by inappropriately persisting in trying to take a history that must ultimately be incoherent).

Disorientation may be unsuspected by the examiner unless tested; short-term memory (as assessed by name and address test or three-object recall) will usually be abnormal.

Formal psychometric tests can be used to confirm the diagnosis and specify the type of defects present, and repeated at intervals to monitor progress. The Mini-Mental State (Folstein et al., 1975) is widely used in UK clinical practice.

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