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BMJ 2008; 337 doi: (Published 03 November 2008) Cite this as: BMJ 2008;337:a2371

At the moment, Alzheimer’s disease is a clinical diagnosis—unless the patient has died and the results of neuropathological examination are available. A biomarker would be an important step forward. Perhaps visinin-like protein 1 is the answer. A study in Clinical Chemistry (2008;54:1617-23, doi:10.1373/clinchem.2008.104497) reports that this marker of neuronal injury is raised in the cerebrospinal fluid of patients with Alzheimer’s disease and that concentrations correlate with scores on the mini-mental state examination. The next step will be to determine whether concentrations of this protein in patients with Alzheimer’s disease differ from those in patients with other causes of dementia.

In a trial of liability in the case of a 10 month old girl in whom the diagnosis of meningococcal disease was delayed, a doctor was found not to have done an adequate examination because he had not assessed level of consciousness. The lesson is that a child should not be assumed to be innocently asleep unless you have checked—it is always necessary to try to wake up an unresponsive …

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