Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project

Abstract

Currently less than half of the estimated number of people with dementia in England receive a formal diagnosis of dementia or have contact with specialist dementia services. Case finding focused on high risk groups may be an effective way to identify the undiagnosed. This joint Surrey Downs Clinical Commissioning Group and Surrey and Borders NHS Foundation Trust quality improvement project aimed to increase the rate of dementia diagnosis across Surrey Downs using specialist link nurses (SLNs).Thirty three GP surgeries covering the entire Surrey Downs area took part in the project. Individuals at high risk of developing dementia were identified from GP electronic disease registers, and were offered screening at their GP practices by SLNs, using a combination of mini cognitive test (Mini-Cog) and functional assessment questionnaire (FAQ). Suitable individuals who screened positive were seen by their GP and where appropriate referred to secondary care services for further evaluation.Based on the presence of risk factors, 6657 (11.9%) people were identified from a total population of 55 845 over 65s, and 1980 (29.7%) completed the screening assessment. Three hundred and fifty eight (18.1%) individuals screened positive and were referred to their GP, who referred 205 (57.2%) of them to the memory services for further assessment. Of those referred, 164 (80%) had a comprehensive specialist assessment. Forty one (20%) declined further assessment, and their GPs were informed.The mean age of the cohort who completed the comprehensive assessment was 82.3 years (SD=4.26), and were predominantly white and male. Fifty four (32.9%) had mild cognitive disorder (MCD), and 101 (61.6%) patients were diagnosed with dementia. The most common dementia was mixed type (43; 42.6%), followed by Alzheimer's dementia (32; 31.7%). The most common risk factor among patients with cognitive impairment (MCD or dementia) was hypertension (69; 44.5 %), followed by ischemic heart disease (64, 41.3%).Nurse led case finding for cognitive impairment in a high risk population identifies people with dementia who are not yet formally diagnosed.The combined use of brief instruments to assess cognitive functioning and functional capabilities is helpful in identifying individuals with possible dementia. ProblemDementia is degenerative disorder with an increasing prevalence. that one third of people with dementia had waited longer than a year to go to their GP with their symptoms. The reasons for this are complex and may include an assumption that memory problems are normal in older age a fear of the diagnosis, a view that little can be done to help, and the perceived stigma of dementia. (7,8)

Automated detection of patients with dementia whose symptoms have been identified in primary care but have no formal diagnosis: a retrospective case–control study using electronic primary care records

“…Our study is a novel contribution to the literature. Studies have previously aimed to detect dementia that was unknown to primary care practitioners, by manual [47][48][49] and automated methods, 28 using data from primary care records. In addition, a recent study by Aldus et al 14 has explored rates and predictors of patients with dementia going undetected.…”

Screening to Assessment Pathways in Evaluating Functional Cognition in Older Adults

“…The Mini-Cog (Borson et al, 2000) is a 2-3 min extensively validated two-part cognitive screening test that incorporates three-word recall (memory) and a clock-drawing test (executive function; Kallumpuram et al, 2015;Patel et al, 2015;Sinclair et al, 2013). Possible scores range from 0 to 5 with lower scores indicating greater impairment.…”

Can Brief Cognitive or Medication Management Tasks Identify the Potential for Dependence in Instrumental Activities of Daily Living?

“…We examined the utility of two brief screening measures, the Mini-Cog (Borson et al, 2003), and a performance-based revision of the Medication Transfer Screen (MTS; Anderson et al, 2008), the Medication Transfer Screen-Revised (MTS-R) separately, and then examined their combination-the Medi-Cog-Revised (Medi-Cog-R)-to determine the most effective screening tool to identify individuals at risk for functional cognition impairment. The Mini-Cog is a widely used screening measure sensitive to cognitive impairments associated with a variety of diagnoses including dementia, diabetes, and heart failure, that has demonstrated clinical utility in primary care, acute care, and community settings (Sinclair et al, 2013;Kallumpuram et al, 2015;Patel et al, 2015). The Mini-Cog has also been used in combination with a medication transfer screening test to identify community-dwelling individuals at risk for medication mismanagement (Anderson et al, 2014).…”