Perception of Benefits and Risks of Neurocognitive Disorders Diagnosis: A French National Survey

Abstract

Background: Neurocognitive disorders (NCD) are underdiagnosed in primary care, mainly because of the misunderstanding of benefits associated with timely diagnosis. Objective: The aim of this study was to explore the benefits and risks of diagnosis in a population of general practitioners (GPs), specialized physicians (SPs), other healthcare professionals (HPs), and informal caregivers (ICs). Methods: A questionnaire was submitted to GPs, SPs, HPs. and ICs. It aimed at evaluating benefits and risks related to NCD diagnosis associated with four prototypical clinical cases at different stages: isolated cognitive complaint/mild NCD, major NCD at mild/moderate stage, moderate stage with behavioral and psychotic symptoms, and severe stage. The concepts of early, timely, and personalized diagnosis were evaluated. Results: A total of 719 completed surveys were collected from 183 GPs, 176 SPs, 281 HPs, and 79 ICs. More than 90% of the participants considered initiating a diagnosis as relevant except at the severe stage. Benefits were superior to risks for all groups and all four cases alike (p < 0.001). Benefits were lower according to GPs and higher for SPs than the other groups at the first two stages (p < 0.001). At the moderate stage, there were few differences between groups. At the severe stage, GPs and SPs claimed it was less relevant to carry out a diagnosis than the other groups (p < 0.001). Risks were higher for ICs and lower for SPs (p < 0.001). The best diagnosis concept was the personalized diagnosis. Conclusion: Benefits appeared more relevant than risks with differences according to the stage of the disease and type of respondents.

What could be the main levers to promote a timely diagnosis of neurocognitive disorders?

“…This study was a national multicenter descriptive survey conducted in France. A standardized selfadministrative questionnaire was sent by email in June 2016 and replies received up to the end of November 2016 were included, as previously described [9]. Participants were free to take part in the study, questionnaires were anonymous, and no incentive was given in exchange for participation to this study.…”

“…However, the first European joint action on Alzheimer 3 Disease (AD) recommended in 2013 a timely diagnosis that should be accessible to all sections of the community at a stage when people first notice changes in cognition or behavior, complain, or present with a situation at risk [2]. At the personal level, diagnosis of NCD is not experienced in terms such notions of time, and it has recently been reported that personalized diagnosis is more pertinent; the latter is defined as a diagnosis strategy in accordance with the dyad patient/caregiver's needs and wills respecting the general principle of autonomy and should lead up to a global and personalized care plan established together with the patient, his or her close caregiver, and all the professionals involved [9,10].…”

“…Diagnosis of NCD is associated with benefits for patients, caregivers and society, for example future planning, elaboration of a suitable care plan, better informed patients and patient relatives who will better understand the symptoms and the course of the disease, access to medical research [9,11,12]. Risks related to a NCD diagnosis are also described, and include stigmatization, isolation, and lack of disease-modifying treatment in particular [9,11,13]. Many studies report that the general population would like to have the diagnosis if they had NCD [14][15][16][17][18][19].…”

“…We previously reported that perception of benefits of a NCD diagnosis workup was stronger than risks, at each stage of the NCD (from subjective cognitive decline to severe major NCD) among general practitioners (GPs), cognition specialized physicians (SPs; i.e. neurologists, psychiatrists, and geriatricians), other healthcare professionals (OHPs), and informal caregivers (ICs) in a national French survey [9]. Herein we will analyze with the same sample of respondents, the relative importance of each main risk and each main benefit from the point of view of GPs, SPs, ICs and OHPs, and at each stage of NCD, but also between respondents.…”

Cognition is a Critical Vital Sign for Older Adults: The Need for Early Detection of Cognitive Impairment is Now

“…Personal benefits of early detection include opportunities to plan for the future, seek education and support, and address potential safety issues, such as the ability to drive and take medications as directed (Garnier-Crussard et al, 2019; Smith et al, 2017). Patients and families want to learn more about their symptoms and condition (Tochel et al, 2019).…”