[Operational criteria for diagnosis of dementia in primary care]

Dementia is a chronic progressive mental disorder, which adversely affects different domains as memory, thinking, comprehension, judgment, orientation, calculation or language. People with dementia eventually lose the ability to carry out routine daily activities such as dressing, toileting, traveling and handling money. Memory impairment and dementia are commonly seen by physicians in multiple disciplines including primary care, geriatrics, neurology, and psychiatry. We discuss the pros and cons of brief cognitive tests such as the Mini-mental State Examination (MMSE) and test for executive functions to detect cognitive impairment in community patients. Diagnosis must meet standard diagnostic criteria, including tests of cognitive, global and behavioral functioning and activities of daily living. Preliminary diagnosis often takes place in primary care, usually followed by specialist assessment. In this paper we discuss operational criteria for diagnosis in primary care. An algorithm for practical physicians is proposed.