GPs should use clinical judgement to adjust test scores for dementia

GPs assessing patients for dementia should rely on clinical judgement over psychological test scores, according to Dr David Anderson, consultant in old age psychiatry at Mersey Care NHS Trust.

Speaking at Primary Care Live, Dr Anderson said a focus on psychological instruments, such the mini mental state exam (MMSE), overlooked the fact that these instruments are validated against clinical judgement.

"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 said that the MMSE test was used particularly badly because it was misunderstood. "In uninformed hands this is an extremely dangerous instrument," he said. "This is a cognitive screening assessment. It is not a diagnostic tool."

"If you use it, be aware of its limitations," he said.

In addition to not being designed as a dementia screening tool, MMSE has an internal variation of three points either side of the score given, it does not include an assessment of executive function and it is greatly dependent on the educational attainment and factors such as depression. An MMSE score needs to be interpreted in the same way as a blood test result, he stressed.

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