Detection of cognitive impairment in the elderly by general internists in Brazil

Abstract

BACKGROUND:Cognitive impairment, from mild forms to dementia, is an important social and health concern, principally among older individuals. Elderly patients are usually followed by general internists, who may overlook this condition.OBJECTIVE:Our aim was to determine whether cognitive impairment diagnosed by specialists had been previously detected by general internists.SUBJECTS AND METHODS:A total of 248 elderly individuals randomly selected from a list of outpatients seen by general internists in a public university hospital in São Paulo, Brazil, were evaluated by a geriatrician. Patients were then classified as having probable cognitive impairment or not, based on their performance on the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly. Cases of probable impairment were submitted to routine laboratory investigation, brain computed tomography, and neuropsychological evaluation. The final diagnoses were established by a consensus panel comprising two neurologists and the geriatrician who evaluated the patients using all available data. General internists' files for all cognitively impaired cases and for a selected sample of individuals without cognitive impairment were checked for any record of cognitive complaints or decline.RESULTS:Forty-three patients were classified as demented (n = 21) or as cognitively impaired but not demented (n = 22). The evaluation of the general internists' files revealed that information on cognitive complaints or decline was recorded for seven (16.3%) of the 43 patients with dementia or cognitive impairment without dementia.CONCLUSIONS:General internists seldom detected cognitive decline in elderly patients in Brazil. Further studies should be conducted to elucidate the reasons for this low rate of detection.

Knowledge and attitudes towards dementia among final-year medical students in Brazil

“…3 However, studies show that patients with dementia are not diagnosed, especially by a general practitioner. [4][5][6] In Brazil, a single published study showed that cognitive decline of the elderly is infrequently detected by general practitioners. 4 Many physicians who have recently graduated from medical school opt for working in the Brazilian Public Health System, which is responsible for attending to about 75% of the population.…”

“…[4][5][6] In Brazil, a single published study showed that cognitive decline of the elderly is infrequently detected by general practitioners. 4 Many physicians who have recently graduated from medical school opt for working in the Brazilian Public Health System, which is responsible for attending to about 75% of the population. 7 Despite the necessity of and curriculum for training in geriatric medicine to make recommendations on an approach to this theme, adequate training appears to occur infrequently.…”

Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile

“…The Mini-Mental State Examination (MMSE), the Verbal Fluency test (FV) and the Clock Drawing Test (CDT) are the cognitive screening tests most frequently used in the world 1,2,3,4 . Studies suggest that a combination of brief cognitive tests can increase the diagnostic accuracy for detecting dementia, in particular Alzheimer's disease (AD), even among illiterate elderly 5 .…”

Estudo psicométrico da Escala de Avaliação de Demência e sua aplicabilidade em instituições de longa permanência no Brasil

“…Cognitive impairment (CI) is one of the main reasons for elders' institutionalization and often contributes for increased dependency in LTCI. Once detected, CI should be followed-up (4) . Most of dementias are not curable diseases, however, there are potentially reversible cases (5) .…”