Setting

This audit is particularly relevant to psychiatrists who investigate suspected dementia, such as specialists in old age psychiatry and intellectual disability, and neuropsychiatrists.

Background

Various guidelines have been published. The National Institute for Health and Clinical Excellence (NICE) and the American Academy of Neurology recommend neuroimaging and blood tests to investigate every patient with suspected dementia. The Canadian Consensus Conference on Dementia and the Royal College of Psychiatrists recommend neuroimaging only when clinical findings point to a possibility other than Alzheimer's disease. Reasons for imaging new referrals include detecting potentially reversible causes of dementia (although the prevalence of such cases is falling) and more accurate diagnosis of dementia subtype.

Standards

The standards were obtained from the NICE guideline Dementia: Supporting People with Dementia and Their Carers in Health and Social Care (National Institute for Health and Clinical Excellence, 2006). The guideline recommends that a basic blood test should be performed at the time of presentation and should include:

ᐅ routine haematology

ᐅ biochemistry tests (electrolytes, calcium, glucose, renal and liver function)

ᐅ thyroid function tests

ᐅ serum B12 and folate levels.

The guideline also states that structural imaging should be used in the assessment of people with suspected dementia to exclude other cerebral pathologies and to help establish the subtype diagnosis. Magnetic resonance imaging (MRI) is the preferred modality but computerised tomography (CT) could be used.

The expectation is that all new referrals should receive a dementia blood screen and neuroimaging.

Method

Data collection

Data were collected in a retrospective review of medical notes. All new referrals to mental health services involving suspected dementia or memory problems were identified. Data collected were:

ᐅ age and sex

ᐅ whether each of the required blood tests had been performed

ᐅ whether the patient had a CT or MRI scan and the result of the neuroimaging (recorded in categories as Alzheimer's disease, small-vessel disease, infarct, mixed pathology, normal, awaiting scan or other).

Data analysis

The percentage of patients who had had each investigation was calculated.

Resources required

People

It is suggested that this audit is undertaken by one or two people.

Time

For approximately 50 referrals it is estimated that data collection would take around 10 hours.