Mini Mental Status Examination for dementia screening

Centre for Quality of Care Research, Department of General Practice and Social Medicine and Department of Geriatric Medicine, University of Nijmegen, Postbox 9101, 6500 HB Nijmegen, Netherlands

Editor—We have a critical comment on the North of England dementia guideline’s emphasis on the use of cognitive screening tests such as the mini-mental state examination by general practitioners. We do not oppose the use of screening tests but emphasise that in a primary care setting general practitioners have different and equally effective means of diagnosing dementia. To illustrate this we report on an evaluation study of the diagnostic accuracy of general practitioners who applied the Dutch national dementia guideline for general practitioners.

In this study a cross sectional comparison was conducted between the diagnoses of a sample of 64 general practitioners and an outpatient memory clinic in the district of Nijmegen in the Netherlands. The general practitioners were recruited by mailing and were representative of the Dutch population of general practitioners regarding age, sex, and practice size. A case finding approach was used, with elderly patients suspected of having dementia being diagnosed according to the national guideline and subsequently referred to the memory clinic. The dementia guideline held diagnostic criteria of the Diagnostic Statistical Manual of Mental Disorders and comprised 29 diagnostic key recommendations for a cognitive, physical, and behavioural examination. A cognitive screening test such as the mini-mental state examination was optional. The memory clinic’s diagnosis acted as a gold standard. We related the general practitioners’ diagnostic accuracy to whether or not they used the mini-mental state examination.