[Can dementia be diagnosed in primary care?]

Abstract

Despite the personal and social value of an early diagnosis, more than 50% of dementias remain undetected. The author shares the view that primary care is an adequate setting for both the detection and diagnosis of dementia. This diagnosis is conducted through clinical interview, physical examination and mental status examination. Once confusional and focal neurobehavioral syndromes have been ruled out, it is useful to differentiate between subjective cognitive complaints, mild cognitive impairment (MCI) and dementia. The target syndrome should be MCI, since more than 50% of these patients develop dementia. In both MCI and dementia an objective and persistent cognitive impairment is detected that, in case of dementia, precludes some of the usual activities. Along with diagnosis, a global plan of care ought to be outlined. This plan should contemplate the prevention of accidents, the management of behavioural and psychological symptoms, the specific pharmacological treatment and caregiver support.

Figura 1

Algoritmo para el manejo de las alteraciones cognitivas en la Atención Primaria. ACL: alteración cognitiva ligera; D: determinaciones; EEM: examen de estado mental; ev.: tiempo de evolución; FRV: factores de riesgo vascular; ICE: inhibidor de la colinesterasa; S: síndrome; TC: tomografía computarizada; U: unidad; Urg.: urgencia.

Figura 2

Modelo jerárquico de interrelación entre el nivel de alerta, la afectividad, la conducta y las funciones cognitivas. A: área; F: funciones.