The Role of Referrals in Diagnosing Dementia at the Primary Care Level

Riedel‐Heller, Steffi G.; Schork, Astrid; Matschinger, Herbert; Angermeyer, Matthias C.

doi:10.1017/s1041610299005815

Cited by 23 publications

(23 citation statements)

References 6 publications

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“…The vascular concept of cognition shows a considerable stability with time. This corresponds to another German survey which by use of questionnaires showed that about three quarters of the 563 participating physicians would diagnose VD much more often than DAT [36,52] .…”

Section: Discussionsupporting

confidence: 79%

“…This is supported by other studies clearly showing that the (subjective) competence concerning treatment and organization of therapy was even lower than that for diagnosis or recognition [3,16,21,31,33,36] .…”

Section: Discussionsupporting

confidence: 77%

“…However, even guidelines developed for FP in Germany recommend at least the application of screening instruments like the Mini-Mental State Examination and the Clock-Drawing Test [22,55] . And other international guidelines recommend screening, when dementia is suspected, too [35,36,56] . About one third of the FP mentioned such tests for their workup.…”

Section: Discussionmentioning

confidence: 99%

“…Other investigators showed that low knowledge as well as dementia-related 'nihilistic' attitudes affect detection rates and case management [16,[36][37][38] . However, diagnostic assessment and disclosure of the results both need skills on the part of the physicians.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Dementia in Primary Care: A Representative Survey of Family Physicians and Neuropsychiatrists in Germany

Stoppe

Haak²,

Knoblauch³

et al. 2007

Dement Geriatr Cogn Disord

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Aim: To measure the diagnostic competence of family physicians (FP) and neuropsychiatrists (NP) for moderate dementia. Methods: Written case vignettes describing moderate dementia either of Alzheimer type or vascular type were randomized to a representative sample of 122 FP and 68 NP, corresponding to response rates of 71.8 and 67.3%, respectively. They served as the basis for a structured face-to-face interview. Results: NP and FP did not differ with regard to their diagnostic considerations, however, concerning diagnostic workup. Vascular dementia was much better recognized than dementia of Alzheimer type. Neuropsychological tests and brain imaging would be done by 14.8 and 32.8% of the FP in the case of vascular dementia. In Alzheimer dementia they would apply these methods in 24.6 and 19.7%, respectively. The corresponding numbers for NP were about 60% in both cases for testing and more than 80% for brain imaging. Conclusions: There is still a wide gap between guidelines and practice in primary care. The apparent overdiagnosis of vascular dementia may be one reason for the low drug treatment rates.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis of Dementia in Primary Care: A Representative Survey of Family Physicians and Neuropsychiatrists in Germany

Stoppe

Haak²,

Knoblauch³

et al. 2007

Dement Geriatr Cogn Disord

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“…Rather, case finding should be performed when history and symptoms cause suspicion of dementia. Many physicians, unfortunately, are not confident in making a diagnosis of dementia [35,36].…”

Section: Discussionmentioning

confidence: 99%

The Effect of the Living Situation on the Severity of Dementia at Diagnosis

Sibley¹,

MacKnight²,

Rockwood³

et al. 2001

Dement Geriatr Cogn Disord

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Introduction: Previous studies have shown that social determinants not directly involved in the disease process may be implicated in the timing of dementia diagnosis. This study explores the relationship between a patient’s living situation and the severity of dementia at diagnosis. Methods: Data were collected from the baseline interviews of 1,325 patients with cognitive decline enrolled in the Consortium for the Investigation of Vascular Impairment of Cognition study. Data collected included: age, sex, living situation and scores on the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), the Functional Rating Scale (FRS), the Disability Assessment for Dementia (DAD) scale and the Cumulative Illness Rating Scale (CIRS). Living situation was grouped as: (1) lives alone, (2) lives with spouse, (3) lives with child, relative or other and (4) lives in a nursing home. A general linear model univariate analysis was used to compare patients by their respective living situations for differences in mean scores on each of the 4 measures of dementia severity. Results: Statistical analysis of both unadjusted data and data adjusted for age, sex and CIRS scores showed significant differences among the groups. Those who lived alone were diagnosed at an earlier stage (mean scores: MMSE 21.4, GDS 3.6, FRS 20.0, DAD 29.8) followed by those who lived with a spouse (mean scores: MMSE 20.5, GDS 3.7, FRS 20.4, DAD 28.0), those who lived with a child or other (mean scores: MMSE 19.3, GDS 3.9, FRS 22.5, DAD 24.9) and finally those who lived in a nursing home (mean scores: MMSE 15.2, GDS 4.8, FRS 27.5, DAD 16.9). Conclusion: Living situation is related to the severity of dementia at diagnosis. Primary care providers should have a low threshold for case-finding in older adults who live with family or friends.

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