Dementia Assessment — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryDementia AssessmentMRCPsych Paper B

A 65-year-old woman is undergoing routine initial assessment for a 6-month history of gradual cognitive decline. There are no features of rapidly progressive or atypical dementia. Which investigation would not routinely form part of the diagnostic work-up?

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Correct answer: A — Lumbar puncture for cerebrospinal fluid biomarkers

The correct answer is A. Lumbar puncture for CSF amyloid and tau biomarkers is not a routine initial investigation for gradual, uncomplicated cognitive decline. NICE recommends considering CSF biomarkers only when Alzheimer’s disease is suspected, the diagnosis remains uncertain after specialist assessment, and clarification of the dementia subtype would change management. CSF examination is also relevant in specialist investigation of rapidly progressive dementia, which is excluded here. Appropriate blood tests are used to identify reversible or contributing conditions; UK pathways commonly include FBC, thyroid function, vitamin B12 and folate. NICE also recommends structural CT or MRI to exclude reversible intracranial pathology and assist subtype diagnosis, unless dementia is already well established and the subtype is clear.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.2.2 and 1.2.13–1.2.16. 2018, updated 2025. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations