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Cognitive Impairment in Primary Care
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
I disagree with Callahan and colleagues [1] that their study was a systematic screening effort for cognitive abnormalities. This contradicts what the authors state as one of the limitations of their study. In an earlier communication [2], in response to an article by White and Davis [3], we noted differences in test characteristics between long (30-question) and short (10-question) mental status examinations. Longer mental status examinations have higher true-positive rates and lower likelihood-negative ratios; shorter mental status examinations have lower false-positive rates and higher likelihood-positive ratios. Consequently, the shorter versions are better for making a diagnosis of cognitive impairment, and the longer mental status examinations are better for ruling out such a diagnosis (screening). With the shorter mental status examination, a positive test result gives the physician more credibility when suggesting further evaluation for cognitive impairment. With the longer version, a negative test (normal) result is more likely to reassure patients, caretakers, and providers that cognitive impairment does not exist and to postpone further work-up.
In future studies, the authors might consider comparing the usefulness of 30-question and 10-question examinations, as did Foreman [4]. It would also be interesting if they could dispel the myth that performing the 30-question examination is more time consuming. I have used a 30-question mental status examination [5] in my practice for many years and have found it helpful. I believe that other primary care providers would be willing to invest the additional time to perform a longer version of the mental status examination if the yield (negative or positive) were higher. Such a practice might also save precious health care resources.
David A. Nardone, MD
Veterans Health Administration Medical Center
Portland, OR 97207
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
