Academic journal article Hong Kong Journal of Psychiatry

Psychogeriatrics in Primary Care-The Invisible Dementia

Academic journal article Hong Kong Journal of Psychiatry

Psychogeriatrics in Primary Care-The Invisible Dementia

Article excerpt


Gases of dementia are often overlooked in the primary care settings. This article illustrates such problem by describing a theorectical case of dementia invisible to a general practitioner and a brief screening test for cognitive dysfunction Short Portable Mental Status Questionnaire (SPMSQ) suitable for use in primary care settings. The SPMSQ has been shown to be a reliable and vaild instructment in many studies although it has not been validated in the local setting. Its usefulness, limitations and aplications are also discussed.

Keywords. SPMSQ, dementia, screening test, primary care


"I am very well, doctor," the frail elderly lady sitting before me squeezed out the sunniest grin I had seen for the whole day.

" Everything is okay, Mrs. Holmes, except that your blood pressure is a bit higher than usual today. Have you forgotten to take your blood-pressure tablets this morning?" 160/100, not too bad actually.

" Oh sorry, Doctor!" I could see her face all flushed with embarrassment. " I must have forgotten to take it. Sometimes I get a bit muddled and forget things. I'll try not to forget again, doctor."

She again gave me such a broad smile that I didn't think I could be harsh on her.

" It's all right. But try not to forget taking the tablets again because it's important to keep your blood pressure stable. You can go now, Mrs. Holmes. Good-bye and take care, and don't forget to make an appointment for your next visit."

It was a fine Friday afternoon that I next heard about Mrs. Holmes. A doctor from the regional psychiatric hospital phoned me up and told me how Mrs. Holmes ways admitted to the psychiatric hospital after the police broke into her house and rescued her not very far from a deadly disaster. Apparently the neighbors, noticing the thickening smokes from her house and unable to get Mrs. Holmes to open the door, had dialed 999 for help. The policemen and firemen found Mrs. Holmes sleeping soundly on the settee in the sitting room while some unidentifiable charcoal masses were furning fiercely in the frying pan on the stove.

But more shocking to them was the chaos they saw inside the house. Dirty dishes and half-finished food were lying here and there. The furniture was covered with filth so thick that obviously they had not been dusted for ages. Unwashed clothing were piled up in the corners mingling with the most unimaginable collections of empty cans and bottles, old newspaper, broken furniture, shopping bags, rotten vegetables and all sorts of peculiar junks probably hoarded from the streets. For a brief moment the policemen had pondered over the possibility of burglary in the house. But soon their doubts were cleared by another discovery: stuffed inside an

* All characters in this article are fictitious and the clinical materials are derived from several cases.

unlocked cupboard in the kitchen were bundles and bundles of bank notes and bags and bags of coins! The policemen counted them and found that they summed up to $ 27,246.80 all in cash!

I listened do all these in total confusion and disbelief. Could it be the same Mrs. Holmes who was sitting before me with a happy smile just a few weeks ago? I was literally dumbfounded and could only uttered some polite noises from my throat while this young doctor went on eagerly to tall me that they had diagnosed Mrs. Holmes to be suffering from a moderate degree of dementia, probably of the multi-infarct type, which ("obviously" as he put it) had been present for some time. I put down the phone completely stricken by a most profound sense of guilt and shame.

I had been attending to Mrs. Holmes ever since I took up this clinic five years ago. She was one of my most charming patients. She never bored me with the long-winding list of complaints I so often loathed in other elderly patients. She would come for her anti-hypertensive drugs now and then but she never complained a thing. …

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