To the Editor: The Rational Clinical Examination article on dementia by Dr Holsinger and colleagues1 notes that as many as 76% of cases of dementia may be missed by primary care physicians. In part this may be because deficits in activities of daily living are a criterion for dementia2 but are not routinely assessed during the medical visit. The authors suggest the Mini-Mental State Examination as a screening tool, but note that it has many limitations.
It is likely that primary care physicians see much of the population with mild cognitive impairment and underdiagnose these patients when using the Mini-Mental State Examination as a screening test. In elderly individuals, it may be of benefit to routinely ask about instrumental activities of daily living (IADLs).
In a systematic review and meta-analysis,3 IADLs were shown to be reasonably accurate for screening for dementia. A study by Mathuranath et al4 developed an IADL scale for elderly individuals that had a sensitivity of 0.91, specificity 0.99, and a positive predictive value 0.76. Its use is based on the concept that the need for integrity within the neuronal web makes these complex tasks more susceptible to pathologic deterioration than to normal aging. An individual with restricted IADL may have a 21.9% probability of developing dementia.5
Therefore, it is possible that simply asking about IADLs (eg, balancing checkbook, driving, shopping for food, and cooking) may yield a sensitive functional and cognitive assessment for mild cognitive impairment and dementia.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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