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Caution urged for GPs who carry out dementia tests

8 October 2008

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GPs are being urged to use clinical judgment when assessing patients for dementia or risk making serious mistakes.

The advice came from Dr David Anderson, consultant in old age psychiatry at Mersey Care NHS Trust, as he addressed the annual Primary Care Live conference in Manchester.

Dr Anderson said psychological instruments such the mini mental state exam (MMSE) could be “extremely dangerous” if a GP’s judgment is not used alongside the tool.

He explained that focusing on an instrument like the MMSE overlooked the fact it is designed to be used in conjunction with clinical judgment, not instead of it.

“People are beginning to believe that the instrument is the gold standard and asking whether we as clinicians can compare with the instrument,” he said.

“But we are the gold standard and it would be a tragedy if these instruments replaced clinical skill and clinical expertise.”

He also pointed to the fact that the MMSE needs to be interpreted in the same way blood test results are. This is because the MMSE has an internal variation of three points either side of the score. It also fails to include an assessment of executive function and is greatly dependent on educational attainment and factors such as depression.

He said: “In uninformed hands this is an extremely dangerous instrument. This is a cognitive screening assessment, it is not a diagnostic tool.

“If you use it, be aware of its limitations.”

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