The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

Dungen, Pim van den; Marwijk, Harm van; Horst, Henriëtte E. van der; Charante, Eric P. Moll van; Vroomen, Janet L. MacNeil; Ven, Peter M. van de; Hout, Hein van

doi:10.1002/gps.2726

Cited by 89 publications

(46 citation statements)

References 60 publications

(90 reference statements)

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“…Although diagnostic criteria for dementia have not substantially changed over the last decades, in early phases of the disease the diagnosis is often not formally made by GPs, even if suspected [24]. However, this leads to high specificity, and therefore high internal validity of diagnostic labels by the GPs [25]. Despite a potentially low sensitivity, the long period of observation ensures that patients with moderate to severe dementia are likely to eventually receive a diagnostic label in their EHR.…”

Section: Discussionmentioning

confidence: 99%

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

et al. 2017

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BackgroundRecent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to be bringing about this effect. The aim of this study was to estimate the age-specific dementia incidence trend in primary care records from a large population in the Netherlands.Methods and findingsA dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRNs) across the country. Data regarding dementia incidence were obtained using general-practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 y and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people for the years 1992 to 2014, corresponding to over 4 million person-years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95% CI 0.5% to 3.8%), and incidence rates were 1.08 (95% CI 1.04 to 1.13) times higher for women compared to men. Despite their relatively low numbers of person-years, the highest age groups contributed most to the increasing trend. There was no significant overall change in incidence rates since the start of a national dementia program in 2003 (−0.025; 95% CI −0.062 to 0.011). Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis by general practitioners in electronic health records, and needs to be taken into account when interpreting the data.ConclusionsWithin the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate a dramatic absolute increase in dementia occurrence over the years to come.

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Section: Discussionmentioning

confidence: 99%

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

et al. 2017

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“…(26–29) Likewise, only one of our patients with low cognitive scores was judged by the intake nurse to be cognitively impaired although on the screening tests 23% scored in a range that suggests probable cognitive impairment (patients with a chart diagnosis of dementia were excluded from the study). While we do not have a “gold standard” and are aware that some of those identified as probably impaired are likely to be normal, our findings that the prevalence of probable impairment in this cohort is similar to that of other community and clinically based studies and that impairment is seldom noted by medical staff strongly suggest that current preoperative evaluation practices are insufficient.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to recognize the problem could lead to suboptimal outcomes in a surgical setting if patients cannot recall what is expected of them pre- or postoperatively in terms of medication regimens, activity restrictions, wound care, and rehabilitation, and one cannot rely on routine clinical interactions to detect cognitive impairment or even frank dementia. (14,23,27–29) Poor preoperative cognitive function may predispose to the subtle and long-lasting executive dysfunction that many seniors experience postoperatively, because the persistent changes are independent of the specific anesthetic or surgical procedure. (33–35) Finally, recent evidence indicates poor cognitive status increases complication risk, undermines the chance of a good outcome, and adds to the cost of care.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Culley

Flaherty

Reddy

et al. 2016

Anesthesia &Amp; Analgesia

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Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. Methods We approached 311 patients ≥ 65 years-old presenting for preoperative evaluation prior to elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible and 63 declined. The remaining 200 were randomized to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. Results The age of consenting patients was 73.7± 6.4 (mean ± SD) years. There were no significant differences between patients randomized to the Mini-Cog or CIB test in age, weight, gender, education, ASA physical status or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P =1.0 by Chi Square analysis). Both tests had good inter-rater reliability (Krippendroff's alpha = 0.86 (0.72–0.93) for Mini-Cog and 1 (1-1) for CIB). Conclusions Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.

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“…Still, although individuals with cognitive impairments contact their physicians more frequently than patients without such impairment, dementia is often not recognised or diagnosed [2,3]. There are many barriers to diagnosis at both the physician and patient level.…”

Section: Introductionmentioning

confidence: 99%

Case-finding of dementia in general practice and effects of subsequent collaborative care; design of a cluster RCT

et al. 2012

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BackgroundIn the primary care setting, dementia is often diagnosed relatively late in the disease process. Case finding and proactive collaborative care may have beneficial effects on both patient and informal caregiver by clarifying the cause of cognitive decline and changed behaviour and by enabling support, care planning and access to services.We aim to improve the recognition and diagnosis of individuals with dementia in general practice. In addition to this diagnostic aim, the effects of case finding and subsequent care on the mental health of individuals with dementia and the mental health of their informal carers are explored.Methods and designDesign: cluster randomised controlled trial with process evaluation.Participants: 162 individuals ≥ 65 years, in 15 primary care practices, in whom GPs suspect cognitive impairment, but without a dementia diagnosis.Intervention; case finding and collaborative care: 2 trained practice nurses (PNs) invite all patients with suspected cognitive impairment for a brief functional and cognitive screening. If the cognitive tests are supportive of cognitive impairment, individuals are referred to their GP for further evaluation. If dementia is diagnosed, a comprehensive geriatric assessment takes place to identify other relevant geriatric problems that need to be addressed. Furthermore, the team of GP and PN provide information and support.Control: GPs provide care and diagnosis as usual.Main study parameters: after 12 months both groups are compared on: 1) incident dementia (and MCI) diagnoses and 2) patient and caregiver quality of life (QoL-AD; EQ5D) and mental health (MH5; GHQ 12) and caregiver competence to care (SSCQ). The process evaluation concerns facilitating and impeding factors to the implementation of this intervention. These factors are assessed on the care provider level, the care recipient level and on the organisational level.DiscussionThis study will provide insight into the diagnostic yield and the clinical effects of case finding and collaborative care for individuals with suspected cognitive impairment, compared to usual care. A process evaluation will give insight into the feasibility of this intervention.The first results are expected in the course of 2013.Trial registrationNTR3389

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The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

Cited by 89 publications

References 60 publications

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Case-finding of dementia in general practice and effects of subsequent collaborative care; design of a cluster RCT

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