An evaluation of the additional benefit of population screening for dementia beyond a passive case‐finding approach

Mate, Karen E.; Magin, Parker; Brodaty, Henry; Stocks, Nigel; Gunn, Jane; Disler, Peter; Marley, John; Pond, Constance Dimity

doi:10.1002/gps.4466

Cited by 9 publications

(11 citation statements)

References 35 publications

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“…A systematic review of trials to increase dementia diagnostic rates found no clearly successful single intervention [ 70 ]. However, a more proactive approach in primary care [ 71 ], in which patients or their families are asked about concerns regarding memory (when suspected) and how they potentially want to proceed, may pave the way for adjusted treatment and care.…”

Section: Discussionmentioning

confidence: 99%

Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia

Sagbakken

Spilker

Nielsen

2018

BMC Health Serv Res

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BackgroundAlong with the ageing of the general population, Europe’s migrant populations are also ageing, thus posing new challenges for dementia care services, particularly if the services are to be adjusted to persons with different linguistic and cultural backgrounds. From the perspective of health professionals, this study aims to explore challenges involved in identifying, assessing and diagnosing people with cognitive impairment/dementia who have different linguistic and cultural backgrounds.MethodsResearch on health professionals experiences regarding the management of dementia among immigrants is scarce and qualitative methods was used to address the objective of the study. Using qualitative in-depth interviews and focus-group discussions, we sought to gather participants’ experiences regarding the diagnostic process for immigrants with dementia. The material was analysed and interpreted based on Kvale and Brinkmann’s descriptions of three different contexts of interpretation: self-understanding, critical common-sense understanding, and theoretical understanding.ResultsHealth professionals described how families could attribute symptoms of dementia to processes of normal ageing, while others saw the symptoms as something shameful; both instances delayed or hindered help-seeking. Many clinicians had limited experience with older immigrants suffering from dementia, and general practitioners (GPs) in particular experienced difficulties assessing dementia due to language barriers and difficulties related to the involvement of the family or an interpreter. The findings illustrate challenges in assessment, such as unfamiliarity with test situations among those being assessed and lack of knowledge regarding appropriate diagnostic tools among health professionals. Lack of continuity and poor information exchange in the chain of care seem to reinforce many of these challenges.ConclusionsDetection, treatment and care may be improved if primary care professionals strengthen their cross-cultural competences. Training in communication skills and in the use of cross-cultural assessment tools may help build competence and confidence when assessing and caring for people with different cultural and linguistic backgrounds. Closer collaboration among families, nurses in home-based services, dementia teams, and GPs may facilitate close monitoring of a patient over time. Such collaboration requires sufficient information exchange during transitions in the chain of care, continuity among health professionals, and a shared understanding of the goals for treatment and care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3720-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia

Sagbakken

Spilker

Nielsen

2018

BMC Health Serv Res

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“…Although educating GPs increased their ability to diagnose dementia, this did not increase diagnostic rates in practice and local campaigns were ineffective on their own. A casefinding approach in primary care, where patients and families are asked about concerns about their memory and intent to act on them, may delineate a group who are more likely to have dementia (250). A recent intervention to increase timely diagnosis by empowering patients led to an increase in patients presenting to the GP but no change in the rate of referral to dementia diagnostic services (251).…”

Section: Timely Detection Of Dementiamentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

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People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

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“…A recent study suggested detecting dementia by case-finding based on subjective memory complaints [ 37 ]. However, we only found that 67.8% of dementia patients self-reported memory decline.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a dementia screening tool for primary care in Taiwan: Brain Health Test

et al. 2018

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ObjectivesTo develop a simple dementia screening tool to assist primary care physicians in identifying patients with cognitive impairment among subjects with memory complaints or at a high risk for dementia.DesignThe Brain Health Test (BHT) was developed by several experienced neurologists, psychiatrists, and clinical psychologists in the Taiwan Dementia Society. Validation of the BHT was conducted in the memory clinics of various levels of hospitals in Taiwan.ParticipantsAll dementia patients at the memory clinics who met the inclusion criteria of age greater or equal to 50 years were enrolled. Besides the BHT, the Mini-Mental State Examination and Clinical Dementia Rating were used to evaluate the cognition state of the patients and the severity of dementia.ResultsThe BHT includes two parts: a risk evaluation and a cognitive test (BHT-cog). Self or informants reports of memory decline or needing help from others to manage money or medications were significantly associated with cognitive impairment. Among the risk factors evaluated in the BHT, a total risk score greater or equal to 8 was defined as a high risk for dementia. The total score for the finalized BHT-cog was 16. When the cutoff value for the BHT-cog was set to 10 for differentiating dementia and a normal mental state, the sensitivity was 91.5%, the specificity was 87.3%, the positive predictive value was 94.8%, and the negative predictive value was 80.1% The area under the receiver operating characteristic curve between dementia and healthy subjects was 0.958 (95% CI = 0.941–0.975).ConclusionsThe BHT is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

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An evaluation of the additional benefit of population screening for dementia beyond a passive case‐finding approach

Abstract: There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.

Cited by 9 publications

References 35 publications

Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia

Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia

Dementia prevention, intervention, and care

Development and validation of a dementia screening tool for primary care in Taiwan: Brain Health Test

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