Why Cant' We All Agree on a Diagnosis?

      So what did our consensus committee agree to?  We agreed to disagree....So much for a consensus.  We all agreed that the patient had depression and should increase his antidepressant.  We all agreed that the patient could not be diagnosed with a dementia.  We did not agree about whether the patient had mild cognitive impairment or not.  We recommended that the patient be treated for depression and once the depression was doing better that he have repeat neuropsychological testing.  If the problem is pseudo-dementia (actually pseudo MCI), then he should do better on the repeat testing.  We also agreed to recommend that the patient stay on the anti-Alzheimer’s medication because if he stopped it before the repeat testing, the results would be confusing.

Well, not only might those results be confusing, but the story about this very complicated patient may be confusing, especially if you have not had the opportunity to read the previous blogs that I referred to.  Let me summarize the major points.  First, depression may mimic dementia in the elderly.  Second, a diagnosis of dementia must include impairment in performance of daily functions.  Third, neuropsychological testing may provide important information.  Fourth, no matter how much information is available, it is still possible for knowledgeable clinicians to be uncertain or disagree about a diagnosis.  Medical care commonly requires decisions about patients be made when the situation is uncertain.  When that is the case, it is the job of the physician to first “do no harm” and to second present the best reasonable course of action to the patient.