Towards evidence‐based dementia screening in Australia

So how can we improve ear ly detection of cognitiveimpairment, and what evidence base do we have for dementiascreening in Australia?A diagnosis of dementia relies on a full mental status assessment,with comprehensive history taking and physical examination. Pres-ently, detailed neuropsychological testing is the gold-standard toolfor objectively evaluating the magnitude and pattern of cognitivedecline. However, neuropsychological evaluation is costly, time-consuming and not generally available as only specialist psychol-ogists can do it. Consequently, general practitioners and specialistphysicians, who evaluate most patients presenting with cognitivecomplaints, administer brief screen ing instruments such as the mini-mental state examination (MMSE) to assess cognition. In Australia,the use of such instruments has been propagated by guidelines forprescribing acetylcholinesterase inhibitors. The MMSE has manydocumented and widely appreciated shortcomings. It lacks diagnos-tic specificity and is insensitive to patient variables such as extremelevels of education, premorbid ability and poor command ofEnglish.