AN ABBREVIATED MINI‐MENTAL STATE EXAM FOR MEDICALLY ILL OLDER ADULTS

59% by CT, 40% by MRI; atrophy in 36% by CT, 40% by MRI, and multiinfarcts in 4.5% by CT and 20% by MRI. EEG recording (20 patients) demonstrated diffuse slowing in 60% and was normal in 40%. There were no focal abnormalities or epileptiform activity identified. The mean MMSE scores were not significantly different when patient groups were compared in reference to CT, MRI, or EEG result. No abnormalities were identified by laboratory testing in all 37 patients studied. In the absence of risk factors or unexpected clinical features, the yield of routine diagnostic tests for reversible causes of dementia is extremely low. In our study of patients with idiopathic PD and the insidious onset of dementia, we have selected a population with pre-existing neurodegenerative disease. It is, therefore, not surprising that the diagnostic screen did not reveal any other etiologies or contributory causes of dementia other than cerebrovascular disease. A larger study would be required to define the actual number of potentially reversible causes of dementia that are present in PD patients. Our data suggests that it would be far less than that found in the general population, but there are a number of factors that may contribute to inaccuracy. In addition to the small sample size, our patient group had a somewhat high mean age and a relatively short duration of disease. It might be argued that these factors indicate that these patients did not have true idiopathic PD but had parkinsonism complicated by dementia. The difficulty of establishing the correct clinical diagnosis in this setting has recently been discussed. " In addition, the Folstein MMSE was not designed to be used as an index of dementia. More specific scales might reveal discrepancies in cognitive performance between patient groups with variable neuroimaging and EEG findings Clinical wisdom supports an individualized and focused diagnostic evaluation for potentially reversible and contributory causes of dementia. Although a practical and realistic approach is required, it is equally important to recognize that the identification and treatment of coexistent medical and psychiatric illness can result in substantial improvement in the patient's daily function. Our study suggests that the most important information for the accurate diagnosis of dementia will be collected at the initial interview and physical examination. Laboratory testing has limited use in identifying treatable causes of dementia, but limited cost and the opportunity to screen for coexisting illness may justify the expense. The use of both EEG and neuroimaging should be individualized and utilized only when appropriate findings on history or physical examination are present. Refraining from a "cookbook" approach to the PD patient with an emerging 1. SutcliffeRLG. Parkinson's disease in the district of the Northhampton Health Authority, United Kingdom. A study of prevalence and disability. Acta Neurol Scand 1985;72:363-379. 2. Girotti F, Soliveri P, Carella F et al. Dementia and cognitive impairment in Parkinson's disease. j Neurol Neurosurg Psychiatry 1988;51:1498-1502. 3. Mayeux R, Stern Y, Rosenstein Ret al. An estimate of the prevalence of dementia in idiopathic Parkinson's disease. Arch Neurol 1988;45:260-263. 4. Mayeux R. The mental state in Parkinson's disease. In: Koller WC, ed. Handbook of Parkinson's Disease, 2nd Ed. New York: Marcel Dekker Inc, 1992:159-184. 5. Weiner Wj. Parkinson's Disease In: Weiner Wj, Lang AE, eds. Movement Disorders: A Comprehensive Survey. Mount Kisco: Futura Publishing, 1989, pp 23-115. 6. Gordon MF, Weiner Wj, Koller WC et al, Case 21994. What Is It? Parkinsonism and Cognitive impairment. Mov Disord 1994;9:679-686.