Intended for healthcare professionals

Rapid response to:

Practice Rational Imaging

Suspected early dementia

BMJ 2011; 343 doi: (Published 20 September 2011) Cite this as: BMJ 2011;343:d5568

Rapid Response:

Re: Suspected early dementia

I recently read the article by Jonathan M Schott on suspected early dementia (BMJ 2011; 343: d5568 doi: 10.1136/bmj.d5568.
I noticed that HIV testing and TPHA screening were not mentioned in the routine work up.
I therefore went to the NICE guidelines:
“Testing for syphilis serology or HIV should not be routinely undertaken in the investigation of people with suspected dementia. These tests should be considered only in those with histories suggesting they are at risk or if the clinical picture dictates”. This is indeed in agreement with the Dutch guidelines.

I wonder on what evidence this is based on how one ever can state that someone has no history suggesting that they are at risk!

This is especially important since we have seen patients in their 50s diagnosed with Alzheimer’s disease who have recovered after treatment for neurosyphilis.
We have seen men and women misdiagnosed with HIV as well.

So I think that the work up in everyone (especially between 50-80) with a diagnosis of dementia shpu;d include HIV and TPHA testing.

Competing interests: No competing interests

08 December 2011
Andy IM Hoepelman
Head Department of Internal medicine & Infectious Diseases
PO Box 85500, F02.126