Rates of Formal Diagnosis in People Screened Positive for Dementia in Primary Care: Results of the DelpHi-Trial

Eichler, Tilly; Thyrian, Jochen René; Hertel, Johannes; Köhler, Leonore; Wucherer, Diana; Dreier, Adina; Michalowsky, Bernhard; Teipel, Stefan J.; Hoffmann, Wolfgang

doi:10.3233/jad-140354

Cited by 95 publications

(92 citation statements)

References 35 publications

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“…In Europe and the US less than 50% of people with clinical dementia receive a formal diagnosis of dementia in primary care. 56 With limited access to specialized care for the majority of cases and countries the penetration of validated biomarkers into routine care may leverage specialized care resources to provide broader access to diagnosis and treatment options for the entire population of people with manifest symptoms of dementing neurodegenerative disorders. This design is replaced by prospective longitudinal repository studies, where the biomarker is measured at baseline in MCI patients, and Alzheimer's disease status ascertained at follow-up.…”

Section: 6mentioning

confidence: 99%

Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers

Frisoni

Boccardi

Barkhof

et al. 2017

The Lancet Neurology

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Biomarkers sensitive to functional impairment, neuronal loss, tau, and amyloid pathology based on MR, PET, and CSF studies are increasingly used to diagnose Alzheimer's disease (AD), but clinical validation is incomplete, hampering reimbursement by payers, widespread clinical implementation, and impacting on health care quality. An expert group convened to develop a strategic research agenda to foster the clinical validation of AD biomarkers. These demonstrated sufficient evidence of analytical validity (phase I of a structured framework adapted from oncology). Research priorities were identified based on incomplete clinical validity (phases II and III), and clinical utility (phases IV and V). Priorities included: definition of the assays; reading procedures and thresholds for normality; performance in detecting early disease; accounting for the effect of covariates; diagnostic algorithms comprising combinations of biomarkers; and developing best practice guidelines for the use of biomarkers in qualified memory clinics in the context of phase IV studies. 5 GlossaryBiomarker. An objective measure of a biological or pathogenic process with the purpose of evaluating disease risk or prognosis, guiding clinical diagnosis or monitoring therapeutic interventions. While the term originally referred to traceable substances produced by or introduced into an organism, it later evolved to any measurable parameter, including those obtained via imaging procedures.Roadmap. Objective-oriented, structured, and efficient action plan. In science and technology also called "strategic research agenda".Alzheimer's disease (AD) dementia. Traditionally and according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria, Alzheimer's disease was defined as a syndrome with progressive cognitive impairment severe enough to impact on daily activities. A diagnosis of Alzheimer's disease could only be made after exclusion of other possible causes. 1 Sixty-five to 80% of cases of patients fulfilling these criteria have Alzheimer's pathology (plaques and tangles), the remainder having a range of other pathologies. In order to increase diagnostic certainty, contemporary criteria for AD dementia incorporate biomarker evidence for different aspects of Alzheimer's pathology, including imaging (magnetic resonance imaging -MRI -measures of atrophy; 18 F-fluorodeoxyglucose-positron emission tomography -FDG-PET -measures of cerebral hypometabolism; amyloid PET measures of fibrillar β-amyloid -A -deposition) and cerebrospinal fluid -CSF (decreased levels of A42, increased levels of tau and phospho-tau). 2,3 Alzheimer's disease process. Recognizing that AD pathology is present many years before symptoms emerge, new criteria classify the disease process on a continuum from asymptomatic to prodromal and finally to dementia stage. 4 Individuals at the asymptomatic stage can only be identified by biomarkers of Alzheimer's pathology. None...

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Section: 6mentioning

confidence: 99%

Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers

Frisoni

Boccardi

Barkhof

et al. 2017

The Lancet Neurology

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534

480

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“…Reliable figures are difficult to determine because the majority (about 60%) of communitydwelling PWD in Germany is not formally diagnosed with dementia [9] and general practitioners (GP) are even less likely to recognize dementia when patients live alone [10].…”

Section: Introductionmentioning

confidence: 99%

Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Eichler

Hoffmann

Hertel

et al. 2016

JAD

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Abstract. Background:Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. Objectives: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. Methods: DelpHi-MV (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). Results: N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drugrelated problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. Conclusion: Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning.

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“…These have been applied in healthcare research close to routine care and have shown their impact on routine care; however, there are healthcare-specific challenges when applying scientific methods in routine care, which are briefly described. [30] oder ergänzt frühere ökonomische Analysen der Kosten der Demenz [31], aber weist auch auf andere Problemfelder hin, z. B. dass ca.…”

Section: German Study On Ageing Cognition and Dementiamentioning

confidence: 99%

Menschen mit Demenz in der primärärztlichen Versorgung

Thyrian

2017

Z Gerontol Geriat

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Rates of Formal Diagnosis in People Screened Positive for Dementia in Primary Care: Results of the DelpHi-Trial

Abstract: The diagnosis rate of dementia in German primary care (40%) is well within the range of the international data (20-50%). The results emphasize the need for action to enhance recognition and differential diagnosis of dementia.

Cited by 95 publications

References 35 publications

Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers

Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers

Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Menschen mit Demenz in der primärärztlichen Versorgung

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