Early Dementia Screening

Abstract

As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1-42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history-hence the need for cost-effective screening measures for early dementia.

Keywords: Alzheimer’s disease; Solanezumab; amnestic mild cognitive impairment; clinical dementia rating scale; cognitive testing; global deterioration scale; mild cognitive impairment; mild neurocognitive disorder; non-amnestic mild cognitive impairment; treatments.

Figure 1

Classification of mild cognitive impairment subtypes with presumed etiology. (A) Amnestic mild cognitive impairment; (B) non-amnestic mild cognitive impairment.