Patients with dementia syndrome in public and private services in southern Brazil

Abstract

Dementia is characterized by deficits in more than one cognitive domain, affecting language, praxis, gnosis, memory or executive functions. Despite the essential economic growth observed in many developing countries, especially over the last century, huge differences remain in health care, whether among nations themselves or across different regions of the same country.ObjectiveThe aim of this study was to assess the management and main features of dementia, comparing public (PUBL) and private (PRIV) reference services.MethodsWe performed a retrospective analysis of medical records of subjects with dementia. Sociocultural data, mean follow-up time in the service, Mini-mental State Examination (MMSE) scores at admission, main diagnosis of dementia, family history of dementia, comorbidities, imaging methods and treatment were assessed.Resultsthe time elapsed before admission in the service of the PUBL group (2.08±2.06 years) was higher than for the PRIV group (1.24±2.55 years) (p=0.0356); the MMSE score at admission in the PUBL group (15.05±8.16 years) was lower than in the PRIV group (18.95±6.69 years) (p=0.016); the PUBL group showed lower treatment coverage with cholinesterase inhibitors (52.94%) than the PRIV group (84.93%) (p=0.0001).ConclusionPatients seeking the public health service have less access to medical care, reaching the system at more advanced stages of disease. The public service also offered lower pharmacological coverage.

Diagnosing dementia and cognitive dysfunction in the elderly in primary health care: A systematic review

“… 14 , 16 Another possible explanation for the absence of studies in low-income countries may be related to the limited access to health services, as well as the limited creation and implementation of public health policies that contribute toward both patient diagnosis and treatment. 14 , 15 , 17 …”

Diagnosis and management of Parkinson’s disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

“…In tertiary centers-based studies, the frequency of these two etiologies ranged from 3.7% to 15% of cases [9][10][11][12][13] Similarly, a study based on neuropathological diagnosis cases 14 showed that LBD caused 15% of cases of dementia, whether isolated or associated with other pathologies. LBD was also the second most frequent neurodegenerative etiology of dementia and related to a higher risk of dementia with an odds ratio (OR) of 3.4 (CI: 1.94-5.97).…”

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…A DDP representa 13,5% dos casos de parkinsonismo com demência 6 , enquanto a DCL é responsável por menos de 5% das etiologias 7,8 . Em estudos baseados nas casuísticas de centros terciários, a prevalência dessas duas etiologias varia entre 3,7 a 15% [9][10][11][12][13] dos casos de demência. Esses dados são similares aos observados em estudo neuropatológico prévio, em que a DCL foi responsável por 15% das etiologias de demência, seja de forma isolada ou associada a outras patologias 14 .…”