Laboratory investigations

Owing to tight budgetary constraints it is sometimes argued that routine laboratory investigations, such as full blood count and chest radiography, are unnecessary for younger adults. Whether or not this is true, with older patients such tests are strongly advised because the treatment of comorbid physical illness improves mental disorder. Furthermore, a treatable or arrestable cause of dementia may be found. For patients with dementia the following are recommended: full blood count; serum electrolytes and creatinine; liver and thyroid function tests; syphilis serology; vitamin B 12 and red cell folate; chest radiography.(4) Medical and nursing staff should also have a low threshold for sending urine for microbiological examination (see superimposed.deiirium below). The vexed question of neuroimaging, an expensive procedure, is much discussed and the debate is not easily summarized or resolved. Most space-occupying lesions can be detected, as can many vascular changes. However, there is nothing pathognomonic for Alzheimer's disease on CT, magnetic resonance imaging, or single-photon emission tomography. In Alzheimer's disease, scans may support the diagnosis but not establish it. The indications for neuroimaging in dementia and other old age psychiatry conditions are discussed by Jacoby.(5)

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