Are mental status questionnaires of clinical value in everyday office practice? An affirmative view

The prevalence of dementia in older people, the poor clinical recognition of this problem by physicians, the opportunities for tertiary prevention, and the availability of reliable and convenient screening instruments all support the value of mental status questionnaires in everyday office practice. These instruments may also be helpful in longitudinal evaluation of patients with known progressive dementias. The case for screening will be substantially stronger when an effective treatment for Alzheimer's disease is found. To avoid inappropriate labeling of patients, abnormal results on a mental status questionnaire must be interpreted with caution. A thorough history is the most effective diagnostic strategy to differentiate progressive dementia from a delirium or a reversible chronic problem. An abnormal score on a mental status screening instrument should never be equated with the diagnosis of Alzheimer's disease. To document the usefulness of mental status screening in office practice, more research is clearly needed. While the value of traditional secondary prevention maneuvers may decrease in the very old, routine, careful assessment of function may prove to assist the family physician in offering important benefits to elderly patients and their families.