The shortage of geriatric specialists in the US may require that primary care physicians (PCPs) receive more education on diagnosing and managing dementia since the number of older Americans with dementia will increase from about five million in 2010 to up to 14 million in 2050. Thus, we administered a brief, anonymous questionnaire to determine PCPs' diagnostic, referral, and management practices to a convenience sample of 142 PCPs in Arkansas. We reworded a Scottish survey to conform to terminology used in the US and added items on referral practices. The PCPs who reported difficulty establishing the diagnosis of dementia had more difficulty telling the diagnosis (O.R = 3.59, p < 0.004). The PCPs were less likely (p < 0.001) to tell the patient if they suspected dementia (73%) than if they were sure the patient had dementia (88%). In both cases, they were more likely to tell the family (92% & 100%, respectively), although this difference was not statistically significant. The PCPs discussed disease progression and driving risks with patients and families, but few referred them to social workers or community agencies. Findings support training PCPs in the diagnosis and management of persons with dementia and providing tools to improve care.
Alzheimer's disease (AD) appears to resemble other chronic diseases, whereby a myriad of interconnected factors, including those associated with lifestyle, are involved in disease development. In this paper, we examine accepted and proposed risk factors for AD and explore health behaviors, including diet, exercise, prevention of injury, and cognitive stimulation, that may help prevent AD. Adherence to a healthy lifestyle may directly protect against AD or may prevent diseases associated with AD, such as vascular disease and diabetes. A healthy lifestyle to prevent AD may be important throughout life rather than after disease manifestation and may be particularly relevant if other factors, such as genetic predisposition, also increase risk of AD. If changes in lifestyle can help prevent AD by reducing modifiable risk factors, this knowledge can aid individuals who wish to take action to protect themselves and their families from the disease.
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