Detection of Dementia in Primary Care: The Linköping Study

Abstract

We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor’s consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.

Dementia in primary care: why the low detection rate?

“…The GPs in our study underestimated the occurrence of dementia, indicating many undetected patients, which is in line with our previous study (14).…”

“…Most of the responders were experienced and had a high proportion of elderly in their practice -conrmed in our previous study, where 40% of attendees were elderly (6,14).…”

“…Whether to give anti-dementia treatment or not depended chie y on the stage of the patient's dementia and on the likelihood of the treatment in uencing the course of the dementia. The high correlation between prescribing a drug and making a diagnosis in medical records has been described in primary care (14). This scepticism about anti-dementia drugs may also explain the low detection rate of dementia.…”

“…We found that dementia was common (20%) among elderly patients visiting a primary care centre (PCC). However, a remarkably low proportion (25%) of these was detected by the GP (12,(14)(15)(16). We therefore planned a questionnaire study to evaluate possible explanations for this low detection rate.…”

Early Anticipation of Dementia; A Step Towards Promoting Community Health: Review of Current Evidence

“…In other words, there is a high probability of the development of dementia in people with cognitive problems in the coming years (2,11). Studies in high income countries show that only one-fifth to one-half of dementia cases are typically recognized and documented in primary care (12)(13)(14)(15)(16). This treatment gap is much greater in low and middle income countries; one study in India showed that 90% remain unidentified (17).…”