Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study

Creavin, Sam; Fish, Mark; Gallacher, John; Bayer, Antony James; Ben‐Shlomo, Yoav

doi:10.3399/bjgp15x686053

Cited by 11 publications

(7 citation statements)

References 43 publications

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“…We previously found that the diagnostic accuracy of simple questions concerning functioning and independent living was comparable to longer more established measures of cognitive functioning in a group of men who had been screened for cognitive problems [ 40 ]. Here we describe a prospective study to evaluate the accuracy of a range of tests for diagnosing dementia in a primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

et al. 2016

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BackgroundPeople with cognitive problems, and their families, report distress and uncertainty whilst undergoing evaluation for dementia and perceive that traditional diagnostic evaluation in secondary care is insufficiently patient centred. The James Lind Alliance has prioritised research to investigate the role of primary care in supporting a more effective diagnostic pathway, and the topic is also of interest to health commissioners. However, there are very few studies that investigate the accuracy of diagnostic tests for dementia in primary care.MethodsWe will conduct a prospective diagnostic test accuracy study to evaluate the accuracy of a range of simple tests for diagnosing all-cause-dementia in symptomatic people aged over 70 years who have consulted with their general practitioner (GP). We will invite eligible people to attend a research clinic where they will undergo a range of index tests that a GP could perform in the surgery and also be assessed by a specialist in memory disorders at the same appointment. Participating GPs will request neuroimaging and blood tests and otherwise manage patients in line with their usual clinical practice. The reference standard will be the consensus judgement of three experts (neurologist, psychiatrist and geriatrician) based on information from the specialist assessment, GP records and investigations, but not including items in the index test battery. The target condition will be all-cause dementia but we will also investigate diagnostic accuracy for sub-types where possible. We will use qualitative interviews with patients and focus groups with clinicians to help us understand the acceptability and feasibility of diagnosing dementia in primary care using the tests that we are investigating.DiscussionOur results will help clinicians decide on which tests to perform in someone where there is concern about possible dementia and inform commissioning of diagnostic pathways.

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Section: Introductionmentioning

confidence: 99%

Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

et al. 2016

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“…Based on the absence of a negative impact of our intervention on mental health, and on the favorable experiences of the FPs and PNs, we would recommend not to be overly careful to discuss and to assess whether or not older persons have cognitive deficits. Based on the comparison of the CAMCOG results with the PNs’ screening results, presently used cognitive tests on their own appear insufficient for the initial detection of (earlier stages of) cognitive decline; we would recommend that initial assessments include a careful history, proxy history and an assessment of functioning [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

et al. 2016

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PurposeDespite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes.MethodsIn a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual.ResultsSeven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60–3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group.ConclusionsWe found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours.Trial RegistrationNederlands Trial Register NTR3389

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“…The GPCOG also asks particularly about difficulties with managing medications, finances, and gadgets as there is evidence that people with dementia may struggle with these tasks. 8 , 9 Younger patients (<70 years) with symptoms that are acknowledged by an informant present a particular challenge, and in practice the authors would exclude affective disorder and then have a low threshold for seeking advice. For older people (>90 years) with multimorbidity (for example, in a nursing home) it might be more appropriate to focus on managing distress and advance care planning.…”

Section: So What Should the Busy Gp Do?mentioning

confidence: 99%

Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community

et al. 2018

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Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study

Abstract: Background

Cited by 11 publications

References 43 publications

Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community

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