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Usefulness of routine blood tests in dementia work-up

  • Kevin Foy (a1), Christian Okpalugo (a2) and Feargal Leonard (a2)
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Department of Health. Living Well with Dementia: A National Dementia Strategy. Department of Health, 2009.
2 Royal College of Psychiatrists. Forgetful but not Forgotten: Assessment and Aspects of Treatment of People with Dementia by a Specialist Old Age Psychiatry Service (Council Report CR119). Royal College of Psychiatrists, 2005.
3 National Collaborating Centre for Mental Health. Dementia: A NICE–SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care. British Psychological Society & Gaskell, 2007.
4 Scottish Intercollegiate Guidelines Network (SIGN). Management of Patients with Dementia: A National Clinical Guideline (Scotland). SIGN, 2006.
5 Clarfield, AM. The decreasing prevalence of reversible dementias: an updated meta-analysis. Arch Int Med 2003; 163: 2219–29.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Usefulness of routine blood tests in dementia work-up

  • Kevin Foy (a1), Christian Okpalugo (a2) and Feargal Leonard (a2)
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eLetters

Screening tests for dementia

Balamurugan Ganesan, ST6/Specialty Registrar
09 December 2009

I read with interest the audit on the laboratory and radiological results of individuals with suspected dementia in an old age psychiatry service(1). I agree with the authors about their observation that only a tiny proportion of these tests identify potentially reversible causes of dementia. However, I would like to spell a word of caution against reducing the use of blood investigations like vitamin B12, folate and thyroid function tests in practice.

In the largest study in terms of sample size(2) the authors found that while a potentially reversible cause was found only in 4% of people with dementia overall, it rose to 19% when limited to people with an youngonset dementia. They also showed that concomitant conditions that were reversible like vitamin B12 deficiency and thyroid deficiency were more frequent in patients with mild cognitive deficits than in patients meetingthe criteria for dementia. Though treatment of these conditions may not always lead to complete resolution of cognitive symptoms it is important to identify any concomitant conditions in this group to prevent a misdiagnosis of dementia. Recent national dementia strategy(3) has also placed a strong emphasis on specialist assessment and accurate diagnosis. While I agree that subjecting a frail older person in his/her 90’s with a clear history of insidious onset and gradually progressive memory loss to all the battery of investigations may be unwise I feel that these investigations should remain an intrinsic part of a comprehensive assessment of someone presenting with a mild cognitive impairment say in their 70’s or earlier.

(1) Foy K, Okpalugo C, Leonard F. Usefulness of routine blood tests in dementia work-up.Psychiatr Bull 2009; 33: 481

(2) Hejl A, Hogh P, Waldemar G. Potentially reversible conditions in 1,000 consecutive memory clinic patients. J Neurol Neurosurg Psychiatry 2002; 73: 390-394.

(3) Department of Health. Living Well with Dementia: A National Dementia Strategy.Department of Health, 2009.

Balamurugan GanesanST6 in Old Age PsychiatryErewash older Adults CMHTIlkeston Resource CentreIlkeston Community HospitalDerbyshireDE7 8TLEmail: balamurgan.ganesan@derbysmhservices.nhs.ukTel: 01159071445Fax: 01159071444
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