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To the Editor: The Rational Clinical Examination article on dementia by Dr Holsinger and colleagues¹ notes that as many as 76% of cases of dementia may be missed by primary care physicians. In part this may be because deficits in activities of daily living are a criterion for dementia² but are not routinely assessed during the medical visit. The authors suggest the Mini-Mental State Examination as a screening tool, but note that it has many limitations.

It is likely that primary care physicians see much of the population with mild cognitive impairment and underdiagnose these patients when using the Mini-Mental State Examination as a screening test. In elderly individuals, it may be of benefit to routinely ask about instrumental activities of daily living (IADLs).

In a systematic review and meta-analysis,³ IADLs were shown to be reasonably accurate for screening for dementia. A study by Mathuranath et al⁴ developed an IADL . . . [Full Text of this Article]

Fernando Coto-Yglesias, MD
fernandocoto@racsa.co.cr
Hospital Nacional de Geriatría y Gerontología
Caja Costarricense de Seguro Social
San José, Costa Rica

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