Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

Abstract

BackgroundGeneral practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction.MethodsThis was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia.ResultsIn our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11 %) were demented. If SST or PMR were abnormal, sensitivity was 71 % (95 % CI 44–90 %), and specificity 64 % (95 % CI 55–72 %) for detecting dementia. If both tests were abnormal, sensitivity was 24 % (95 % CI 7–50 %), but specificity increased to 93 % (95 % CI 88–97 %).ConclusionPatients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0094-0) contains supplementary material, which is available to authorized users.

Olfactory function is associated with cognitive performance: results from the population-based LIFE-Adult-Study

“…Our results support the findings of other studies that the association of olfactory and cognitive performance goes beyond the effects of aging [1, 8, 12, 14, 20]. Other population studies that investigated this topic, albeit in older or at risk of developing cognitive impairment populations, came to the same conclusion [13, 22–24].…”

“…Devanand et al suggested the use of odor identification tests as an early marker of cognitive decline, in the clinical setting, or for further treatment research in their 2015 study [20]. Streit et al concluded a smell test could be of benefit in cases of suspected dementia, but together with neurocognitive tests in their 2015 study [14].…”

“…While olfaction tests do seem to be easy and relatively cheap to perform, olfactory identification tests alone may be insufficient or not sensitive enough as a predictor of cognitive impairment [9, 10]. A combination of the common cognitive diagnostic tools and an olfaction test has been put forward as a better way to detect cognitive impairment, preferably at earlier stages [14, 15]. Several studies from 2016 also concluded olfactory testing would be useful in the detection of cognitive decline.…”

Extremely low frequency electromagnetic field reduces oxidative stress during the rehabilitation of post-acute stroke patients

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Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol

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