Screening for dementia in primary care: a review of the use, efficacy and quality of measures

Milne, Alisoun; Culverwell, Alison; Guss, Reinhard; Tuppen, Jackie; Whelton, Rebecca

doi:10.1017/s1041610208007394

Cited by 193 publications

(154 citation statements)

References 49 publications

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“…However, this can take up to 20 min to complete and may not be practical for use in primary care. The General Practitioner Assessment of Cognition (primary care physician COG) (Brodaty et al, 2002), and two other cognitive screening tests, the Mini-Cog Assessment Instrument (Borson et al, 2000) and the Memory Impairment Screen (MIS) (Buschke et al, 1999), have been found to be as clinically and psychometrically robust and more appropriate for use in primary care than the MMSE (Milne et al, 2008). The primary care physician COG is estimated to take 5-7 min to complete with questions for both the patient and family carer, and thus may be more relevant for primary care physicians (Brodaty et al, 2002).…”

Section: Assessment Of Cognitive Functionmentioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

168

154

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SUMMARYObjectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community. Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia. Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required.

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Section: Assessment Of Cognitive Functionmentioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

168

154

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“…A quick glance through an issue of International Psychogeriatrics pulled from my shelves at random (20 (5), October 2008), revealed that of 16 review or original research articles, five (31%) (Lyketsos et al, 2008;Mendes-Chiloff et al, 2008;Milne et al, 2008;Nakaaki et al, 2008;Orrell et al, 2008) cited Folstein's MMSE. It therefore caused me little surprise to find that that the valuable contribution of Han et al (2000) in establishing a typical rate of decline for AD patients assessed with the MMSE had received the equal sixth highest number of citations of any paper published in the journal up to the end of 2006.…”

Section: Commentarymentioning

confidence: 99%

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6c. TRACKING COGNITIVE DECLINE IN ALZHEIMER'S DISEASE USING THE MINI-MENTAL STATE EXAMINATION: A META-ANALYSIS (“MINI” IS NOT NECESSARILY TRIVIAL!)

Han

2009

Int. Psychogeriatr.

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It was well beyond my expectations when I heard from Professor Ames that our meta-analysis paper (Han et al., 2000) was among the top-cited papers in International Psychogeriatrics. As an expression of my gratitude to the editor for the invitation and to the audience of this paper, I would like to offer this informal discussion on the background of the paper and extend a few ideas that were not conveyed fully at the time, due either to insufficient knowledge or unavailability of relevant data or methodologies.

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“…Because damage caused by the pathophysiologic mechanisms associated with AD is presumed to be irreversible, early detection of AD offers better prospects for patients with AD and their families and friends. This allows both the patient and family to participate in their care plan and to prepare better for future challenges as a result of the neurodegenerative process 26,27 because currently available medications, and any future disease-modifying agents, will have the greatest opportunity for providing benefit. In addition, recent evidence suggests that early treatment provides economic benefits both to the patient and caregiver as well as society as a whole.…”

Section: Importance and Challenges Of Early Diagnosismentioning

confidence: 99%

“…Both have psychometric properties superior to the MMSE; as such, they are clinically and psychometrically robust and, it has been argued, are more appropriate for routine use in primary care. 27,46 Step 3: Assessment of Daily Functioning An assessment of daily function is vital to determine the extent of the patient's disability and dependence on the caregiver, the results of which help to enable planning to maximize patients' independence. 47 Basic ADLs, such as feeding and toileting, can be assessed with an interview or by using a tool such as the ADL Scale.…”

Section: Informant-based Screening Toolsmentioning

confidence: 99%

Practical Guidelines for the Recognition and Diagnosis of Dementia

Galvin

Sadowsky²

2012

The Journal of the American Board of Family Medicine

162

120

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To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver sta- Dementia: an OverviewAlzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of all cases, 1,2 and it is therefore the main focus of this article. AD destroys brain cells, causing problems with memory, thinking, and behavior severe enough to affect work, family, and social relationships and, eventually, the most basic activities of daily living (ADLs). AD and related disorders are a growing public health problem in the United States, with a prevalence ranging from 3% to 11% among people aged 65 years and older and from 25% to 47% among those aged older than 85 years. 3,4 There are an estimated 5.3 million cases of dementia in the United States, 5 and this number is expected to increase to 18.5 million by 2050. 6 The number of those afflicted is increasing annually as a result of the aging population. Dementia leads to a high burden of suffering for patients, families, and society, with an annual estimated cost of $172 billion. 5 People with dementia usually present first to their family physician, although an estimated 39% present to specialist clinics (neurologists, psychiatrists and geriatricians). 7 The primary care physician (PCP) is often the first physician to observe patients with possible dementia and often the only physician involved in making the diagnosis. 8 Because of the key role that PCPs play in the longterm management of elderly individuals with chronic disease, the growing number of patients with dementia will have a significant impact on these health professionals. 9 The rising number of patients with dementia means that family physicians will have an increasingly important role in recognizing early signs and symptoms of disease, ordering appropriate tests, formally diagnosing, and, finally, treating these patients. However, at present, diagnosing AD can be Funding: none. Conflict of interest:Dr Sadowsky has served as a consultant to Novartis Pharmaceuticals Corporation, has served as a speaker for Novartis Pharmaceuticals Corporation and Forest Pharmaceuticals and Accera, and has received honoraria from these companies. James E Galvin is a paid consultant for ...

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Screening for dementia in primary care: a review of the use, efficacy and quality of measures

Cited by 193 publications

References 49 publications

Primary care and dementia: 1. diagnosis, screening and disclosure

Primary care and dementia: 1. diagnosis, screening and disclosure

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6c. TRACKING COGNITIVE DECLINE IN ALZHEIMER'S DISEASE USING THE MINI-MENTAL STATE EXAMINATION: A META-ANALYSIS (“MINI” IS NOT NECESSARILY TRIVIAL!)

Practical Guidelines for the Recognition and Diagnosis of Dementia

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