Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy)

Abstract

Increased numbers of referrals would be consistent with an awareness raising effect of NICE/SCIE and NDS and a willingness among GPs to refer cases. But the falling proportion of dementia diagnoses suggests that these are 'worried well' individuals. There is no evidence for closure of the dementia 'diagnosis gap'.

Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic

“…A cross- (Figure 1) [5]. They attribute this to raised awareness of referral guidelines and increasing referrals and suggest that many of those without dementia were the worried well or had depression…”

Distinctive neuropsychological profiles differentiate patients with functional memory disorder from patients with amnestic-mild cognitive impairment

“…However, for these strategies to be most effective, accurate screening by General Practitioners and early distinction of progressive neurodegenerative memory problems from other causes of memory complaints is required. There is evidence that, at present, screening procedures are not working well and that the proportion of patients without dementia is increasing in memory clinics (4)(5)(6) The label 'Functional Memory Disorder' (FMD) has been proposed to describe those patients who experience subjective memory complaints and present to memory clinics but do not have an underlying neurodegenerative or psychiatric cause (7). Diagnostic criteria for FMD have been proposed by Schmidtke and colleagues (8), and include subjective memory complaints that affect functioning in everyday life, have been present for more than 6 months, and cannot be explained by a clear psychiatric cause.…”

Evaluación del minimental abreviado de la evaluación funcional del adulto mayor (EFAM) como screening para la detección de demencia en la atención primaria

“…Uno de los principales argumentos para justificar su uso es el supuesto aumento en el número total de casos diagnosticados. Sin embargo, el seguimiento en el tiempo de este tipo de estrategias ha demostrado que aumenta el número de derivaciones a los centros secundarios a expensas de sujetos sanos, sin un impacto real en la oportunidad del diagnóstico de la demencia 24 . Una posible explicación para el mal rendimiento de este tipo de instrumentos es que el estándar de normalidad se define en relación al desempeño de una población de referencia y no al desempeño pre mórbido del sujeto.…”