An evidence-based clinical approach to the diagnosis of dementia.

With the rapidly ageing population in Singapore, dementia prevalence is on the rise. Early diagnosis is important as dementia impacts not only on patients and their families, but also on the community and healthcare system as a whole; with early treatment plans drawn up, the suffering associated with this illness can be more effectively and efficiently managed. In this paper, we present a 4-step, evidence-based assessment strategy for primary care physicians, which cover the essential objectives of the dementia evaluation, incorporating local data where possible. The first step requires the important exclusion of delirium as the cause of forgetfulness or confusion. The second step involves clinically establishing that the patient's chronic confusional state is due to dementia. The third step looks at the behavioural, functional and social dimensions of dementia. The final step determines the aetiology of dementia with the use of a focused history, physical examination, a predefined battery of haematological tests and, in selected cases, structural neuroimaging.