Screening for dementia and investigating its causes

Article Abstract:

Diagnosing dementia is becoming an increasingly important problem for the primary care physician. It is estimated that as many as 10 percent of the elderly people over 65 living in the community have Alzheimer's disease, and that many of these cases are not recognized by physicians. However, other problems arise when signs of dementia are noticed by physicians. In the overwhelming majority of cases, there is little that can be done to reverse or halt the development of dementia. However, in a small minority of cases, mental deterioration can be halted; an example of such a case is tertiary syphilis, which can be treated with antibiotics. It is not always clear how much effort should be expended to rule out treatable causes of mental decline that are quite unlikely to be present. A review was conducted of publications in the medical scientific literature to tabulate the diagnostic findings of dementia and the results of testing for particular causes of dementia. This review was conducted from the standpoint of the primary care physician, who must make decisions about how individual cases should be followed-up. The results confirmed that dementia is a difficult diagnosis that is more easily ruled out than confirmed. Some tests of cognitive ability, such as remembering seven digits, are likely to rule out dementia if performed well, but do not indicate dementia if performed poorly. The tabulation of the results from studies on dementia indicate that routinely investigating the cause of dementia is not warranted. Studies such as syphilis testing, the measurement of cobalamin for signs of vitamin B12 deficiency, and brain imaging studies, are not justified for routine use, but only if some feature of the patient's history suggests that a test might be useful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Testing

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The medical consultant's role in caring for patients with hip fracture

Article Abstract:

Physicians can provide many services to hip fracture patients before and after surgery. Researchers surveyed the medical literature to identify studies that assessed the role of the internist in the timing of surgery, the use of drugs before surgery to prevent infection, postoperative nutritional advice, and the provision of rehabilitation services. Many of the studies provided strong evidence that internists could improve the outcome of hip surgery by providing these services.

Care and treatment, Practice, Fractures (Injuries), Fractures, Hip joint, Hip fractures, Internists

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Screening for dementia in primary care settings

Article Abstract:

There is not enough evidence to recommend or not recommend screening for dementia, according to the U.S. Preventive Services Task Force. Screening usually means testing people for a particular disease even though they have no symptoms. However, this should only be done if there is a good diagnostic test and effective treatments. The problem with dementia is that there is no quick diagnostic test and very few effective treatments.

Evaluation

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