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.

tom.moberly@haymarket.com

Comment below and tell us what you think

 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Viewpoint: More trust and less red tape must define post-COVID GP world, says RCGP chair

Viewpoint: More trust and less red tape must define post-COVID GP world, says RCGP chair

A high-trust approach to regulating GPs has paid dividends during the COVID-19 pandemic,...

How our practice is supporting staff wellbeing during the pandemic

How our practice is supporting staff wellbeing during the pandemic

Dr Vasu Siva explains the steps her practice has taken to support staff to look after...

GPs to contact all children on shielding lists this summer

GPs to contact all children on shielding lists this summer

GP practices will be asked to contact thousands of children on shielding lists over...

Fever in adults - red flag symptoms

Fever in adults - red flag symptoms

Pyrexia in adults has a wide range of differential diagnoses. Dr Pipin Singh provides...

GMC to restart fitness to practise cases and PLAB tests within weeks

GMC to restart fitness to practise cases and PLAB tests within weeks

Fitness to practise cases paused during the coronavirus pandemic will restart this...

NHS England confirms plan to add practice managers to £20,000 golden hello scheme

NHS England confirms plan to add practice managers to £20,000 golden hello scheme

NHS England hopes to extend the £20,000 golden hello scheme for first-time partners...