title: Evaluation of dementia: the case for neuroimaging all mild to moderate cases.
abstract: BACKGROUND
  The aim of this study was to assess the usefulness of 4 clinical prediction rules, the neuroimaging guidelines from the Canadian Consensus Conference on Dementia (CCCAD) and the modified Hachinski's Ischaemic Score (HIS) in identifying patients with suspected dementia who will benefit from neuroimaging.
  
  
  METHODS
  Two hundred and ten consecutive patients were referred to the memory clinic in a geriatric unit for the evaluation of possible dementia. Sensitivity, specificity and likelihood ratios (LR) were calculated for each of the prediction rules and the CCCAD guidelines, in terms of their ability to identify patients with significant lesions [defined firstly as space-occupying lesions (SOL) alone and secondly as SOL or strokes] on neuroimaging. Similar analyses were applied for the HIS in the detection of strokes.
  
  
  RESULTS
  When considering SOL alone, sensitivities ranged from 28.6% to 100% and specificities ranged from 21.7% to 88.4%. However, when strokes were included in the definition of significant lesions, sensitivities ranged from 16.2% to 79.0% and specificities ranged from 20.9% to 92.4%. The modified HIS had a similarly poor sensitivity and specificity (43.3% and 78.9% respectively). The LR for the clinical decision tools did not support the use of any particular instrument.
  
  
  CONCLUSIONS
  Clinical decision tools do not give satisfactory guidance for determining the need for neuroimaging patients with suspected dementia, when the detection of strokes, in addition to SOL, is regarded as important. We recommend therefore that neuroimaging be considered for all patients with suspected mild or moderate dementia in whom the potential benefits of any treatment outweigh the potential risks.
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. syympc@pacific.net.sg
authors.forename: Yih-Yiow
authors.initials: YY
authors.lastname: Sitoh
authors.forename: Kala
authors.initials: K
authors.lastname: Kanagasabai
authors.forename: Yih-Yian
authors.initials: YY
authors.lastname: Sitoh
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Suresh
authors.initials: S
authors.lastname: Sahadevan
mesh_terms: D000368:Aged; D003704:Dementia / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed