Diagnosis of Dementia

Stanley I. Rapoport, MD, is Chief of the Laboratory of Neurosciences, National Institute on Aging, Bethesda, Maryland. Synopsis Using standardized history, physical and neurological examinations, laboratory evaluation, and tests of cognitive performance, mood, and functional status, 155 patients admitted consecutively to an outpatient dementia clinic were diagnosed as "demented" or "nondemented." Diagnostic groups were: primary degenerative dementia (60 percent); multi-infarct dementia (7.1 percent); mixed degenerativevascular dementia (12.3 percent); miscellaneous dementias (11.6 percent); referral group with normal test scores (9 percent). The Hachinski Ischemic Score distinguished (p < 0.05) the multi-infarct and mixed degenerative-vascular dementia groups from the nondemented subjects. The Mini-Mental State Examination Score, which indicated that the demented patients were, on an average, moderately demented (mean score 11 to 21), was highly correlated (r = 0.91) with the Blessed Memory, Information and Concentration Test. Both equally discriminated the demented groups from the nondemented group. Functional impairment, as measured by the Katz Index ofActivities ofDaily Living, was moderate in the demented patients. For the primary progressive dementia patients, severity ofdementia was correlated with duration, functional impairment, and depressive symptoms.