Due to the low detection rate of dementia especially in older persons with multimorbidity I think it is a very good idea to ensure a more suitable dignified care of old people.

Anne Ekdahl - Sweden

Far more valuable than any finding of cognitive damages is to do something that it will not occur, and then to prevent further deterioration. Unfortunately, neurology and psychiatry do not have the means to fulfill these ideals. I think all the energy invested by these disciplines and by the related ones should be targeted towards finding solutions for this goal! In recent years there has been a rapid increase in research of the link between vitamin D and brain function. Today there is little substance to show measurable capacities better than vitamin D for prevention / improvement of cognitive function

I think the test should be adapted in order to allow to family doctors and to medical personnel specially trained the detection of sufficiently small changes in cognitive functions, modified for better or worse, during the administration of

enough vitamin D3 (or something similar) in repeated doses to allow serum levels of 25-OH-D around 60-70 ng/ml throughout the year. Experts like you and your colleagues at Saint Louis University and in the world should launch a global campaign for the quick implementation in the primary care of an as widely as possible study responding to the question: "Can vitamin D slow mental deterioration?

John,

Agree that older adults should be examined for cognitive impairments. But, we should also draw a line, somewhere. Blood tests are not done for all patients visiting health professionals! Why shouldn't we follow that example for cognition? Not sure, if time/cost efficiency justifies doing screening tests, either. When looking at the staggering number of wrongly diagnosed AD patients (some say >45%), I really become suspicious of screening measures efficacy (even though as a board certified clin psych, I should be defending these measures).

But, performing better than MMSE, is promising for RCS. I was wondering if the RCS has been examined against MOCA? Thanks.

It would be amazing to screen all patients over 65 (45 for Aboriginal and Torres Straight Islander patients)for cognitive impairment, however I think it would come down to cost unfortunately.

The other concern is that we are directing this as a screening tool for capturing mild cognitive impairment in the geriatric population but this will not include the ever growing "early onset" patients.

How much time is allocated in a GP visit for a health assessment of a geriatric patient and how much funding is allocated for this health assessment?

 In most published studies I've read, 2/3 of every sample carrying "MCI" dx does not progress to dementia at 5-7 yr follow up.  I have run support groups and known several pts who became suicidal post-dx.  Given the acute psychological stigma, until data show a more consistent and robust link between MCI & dementia, screening is premature unless pt or caregiver reports major life disruption due to related sx. Consistent data do show that subjective memory complaint is often mood (depression/anxiety) or even personality related.

http://www.ncbi.nlm.nih.gov/pubmed/24094300

Article Current Management Decisions in Mild Cognitive Impairment

In my experience, these screenings by GPs and others almost invariably lead to diagnosis of dementia mainly because, if done first, there has been no opportunity to perform the rquired physical examination - including vision, hearing, medications, and other mimics of cognitive impairment. I find it a potentially dangerous practice leading to overdiagnosis.