Group screening for cognition disorders in elderly persons.

Prevalence rates of cognitive impairment in persons aged 75 to 85 years are in the range of 10 to 19 percent, and 20 to 47 percent after the age of 85 years. Screening for dementia in persons aged 75 years and older would therefore identify a significant number of impaired persons. When screening for dementia, group testing would be more cost-effective than individual testing. We modified the Folstein Mini-Mental State examination (MMSE) for screening in a group setting. Community volunteers were tested at a geriatric health fair and at a special exercise class for the elderly. Subjects were subsequently tested individually using the standard Folstein MMSE. Analysis using Pearson correlation and a paired t-test indicates a high degree of concurrent validity between the two methods of administering the MMSE. This pilot study suggests that when screening elderly persons for dementia, a group-administered instrument can be a useful method to obtain a preliminary sample of cognitively impaired individuals.

Use of a hearing assistance device in nursing homes.

An inexpensive hearing assistance device can improve communication with nursing home residents. In patients who do not have prescribed hearing aids or who are being audiologically evaluated, voice amplification with such a device facilitates initial assessment as well as ongoing care. Such devices are available at local consumer outlets for under $30, making them available to persons who are unable to afford more sophisticated models.

Reevaluation of patients on thyroxine therapy.

A 21-day withdrawal test was utilized at four primary care practice sites to reevaluate individuals on thyroxine therapy. Utilizing elevated thyroid stimulating hormone (TSH) concentrations as the standard for diagnosing hypothyroidism, 22 of 37 patients previously on thyroxine were found to be euthyroid. Of the 15 hypothyroid individuals identified, 13 had elevated serum TSH 21 days after withdrawal of thyroxine. Two individuals who had serum TSH concentrations in the normal range at 21 days became symptomatic at five and eight weeks, respectively, and were found to have elevated serum TSH. Several factors may account for the high percentage of euthyroid individuals being treated with thyroid medication. These include unreliability of symptoms as a basis for diagnosis of hypothyroidism, laboratory tests that are often difficult to interpret, the commonly held misconception that all forms of primary hypothyroidism are irreversible, the routine use of thyroxine by many surgeons after subtotal thyroidectomy, and the use of thyroxine to suppress diffuse or nodular goiter.

Re-evaluation of thyroid hormone status after long-term hormone therapy.

Once thyroid hormone is prescribed, it is usually continued throughout a persons's lifetime. It is therefore important that the diagnosis be based on the most definitive test available. In this study with a primary care population of 6,000 individuals, 24 patients were found to carry the diagnosis of hypothyroidism. A careful view of the records showed that the diagnosis was inadequately documented by current standards in 20 of these 24 individuals. A 21-day hormone withdrawal test was done in ten of the patients in whom the diagnosis was suspected, and 60 percent were found to be euthyroid. Although the number of patients was small, this does encourage the speculation that many patients diagnosed in the past as hypothyroid may in fact be euthyroid. The medical as well as economic impact of this high rate of misdiagnosis becomes apparent when the one contemplates the 15,000,000 prescriptions for thyroid hormone written annually in the United States.