Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people

Creavin, Sam; Noel-Storr, Anna; Langdon, Ryan; Richard, Edo; Creavin, Alexandra L; Cullum, Sarah; Purdy, Sarah; Ben-Shlomo, Yoav

doi:10.1002/14651858.cd012558.pub2

Cited by 8 publications

(10 citation statements)

References 144 publications

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“…47 In the context of primary care, meta-analyses found that general practitioners achieved an F1-score of 0.735 when screening for dementia and an F1-score of 0.785 when screening for cognitive impairment. 2 Our pipeline, using only primary care-accessible features (tier 1), outperformed these findings, with an AD dementia screening F1-score of 0.919 and a cog-nitive impairment screening F1-score of 0.889. These results were robust across classification methodology.…”

Section: Discussionmentioning

confidence: 71%

Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's

Ren,

Shahbaba,

Stark

2023

Alz & Dem Diag Ass & Dis Mo

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INTRODUCTIONTo reduce demands on expert time and improve clinical efficiency, we developed a framework to evaluate whether inexpensive, accessible data could accurately classify Alzheimer's disease (AD) clinical diagnosis and predict the likelihood of progression.METHODSWe stratified relevant data into three tiers: obtainable at primary care (low‐cost), mostly available at specialty visits (medium‐cost), and research‐only (high‐cost). We trained several machine learning models, including a hierarchical model, an ensemble model, and a clustering model, to distinguish between diagnoses of cognitively unimpaired, mild cognitive impairment, and dementia due to AD.RESULTSAll models showed viable classification, but the hierarchical and ensemble models outperformed the conventional model. Classifier “error” was predictive of progression rates, and cluster membership identified subgroups with high and low risk of progression within 1.5 to 3 years.DISCUSSIONAccessible, inexpensive clinical data can be used to guide AD diagnosis and are predictive of current and future disease states.HIGHLIGHTS Classification performance using cost‐effective features was accurate and robust Hierarchical classification outperformed conventional multinomial classification Classification labels indicated significant changes in conversion risk at follow‐up A clustering‐classification method identified subgroups at high risk of decline

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Section: Discussionmentioning

confidence: 71%

Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's

Ren,

Shahbaba,

Stark

2023

Alz & Dem Diag Ass & Dis Mo

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“…This month's Cochrane Review (Creavin 2022) aimed to assess the clinical accuracy of GPs in diagnosing two target conditions: dementia and mild cognitive impairment. This article will focus on the primary outcome analysed, namely, the clinical accuracy of GPs in diagnosing dementia, as defined by sensitivity and specificity (Box 2).…”

Section: The Cochrane Reviewmentioning

confidence: 99%

“…For instance, there may be delays in seeking help due to poor recognition and understanding of symptoms as well as a reluctance to seek help because of stigma (National Collaborating Centre for Mental Health 2018). Primary care services are often the first point of contact for people with dementia and therefore form an important interface in determining which patients require referral to specialist services for further assessment (Pentzek 2019; Creavin 2022). In fact, previous studies have found that a general practitioner's (GP's) clinical judgement is a known added predictor for identification of individuals at risk of dementia (Box 1) (Pentzek 2019).…”

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confidence: 99%

Clinical judgement of general practitioners: an effective tool in the diagnosis of dementia?

Rajgopal,

Singh

2023

BJPsych advances

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SUMMARY The diagnosis of dementia poses several challenges, as a consequence of which the condition has been widely reported to be underdiagnosed in the general population. Currently, there is no single diagnostic test for dementia and the clinical judgement of primary care physicians is therefore a key determinant in identifying which patients are referred to specialist services for further assessment. This month's Cochrane Corner review found that the clinical judgement of general practitioners is more specific (58–99%) than sensitive (34–91%) in diagnosing dementia, although the data were limited by small sample size and significant heterogeneity. This commentary provides a critical appraisal of this systematic review and attempts to extrapolate conclusions relevant to current clinical practice, including potential areas of further research, to facilitate appropriate and timely referral of patients with suspected dementia to specialist services.

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“…Alzheimer's Disease International estimate that, on average, > 75% of people living with cognitive complaints or impairment are undiagnosed worldwide 3 and post mortem studies report misdiagnosis rates of up to 30% 4 . Furthermore, a meta‐analysis reported that the clinical judgment of general practitioners had a sensitivity of 58% and a specificity of 89% in the diagnosis of dementia, meaning that false negative diagnoses are likely 5 …”

Section: Introductionmentioning

confidence: 99%

“…4 Furthermore, a meta-analysis reported that the clinical judgment of general practitioners had a sensitivity of 58% and a specificity of 89% in the diagnosis of dementia, meaning that false negative diagnoses are likely. 5 Globally, there is no standardized AD diagnostic pathway. 6 At present, symptomatic individuals with clinical suspicion of AD undergo a combination of clinical history taking, cognitive assessments, routine laboratory tests (e.g., blood and/or urine tests), and structural brain imaging (e.g., computed tomography or magnetic resonance imaging…”

Section: Introductionmentioning

confidence: 99%

The potential clinical value of plasma biomarkers in Alzheimer's disease

Blennow,

Galasko,

Perneczky

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONMany people with cognitive complaints or impairment never receive an accurate diagnosis of the underlying condition, potentially impacting their access to appropriate treatment. To address this unmet need, plasma biomarker tests are being developed for use in Alzheimer's disease (AD). Plasma biomarker tests span various stages of development, including in vitro diagnostic devices (or tests) (IVDs), laboratory‐developed tests (LDTs) and research use only devices (or tests) (RUOs). Understanding the differences between each test type is important for appropriate implementation into the AD diagnostic pathway and care continuum.METHODSAuthors reviewed scientific literature (PubMed, meeting abstracts and presentations, company press releases and websites) on AD plasma biomarkers.RESULTSThis article defines IVDs, LDTs, and RUOs, discusses potential clinical applications and highlights the steps necessary for their clinical implementation.DISCUSSIONPlasma biomarkers could revolutionize many areas of the AD diagnostic pathway and care continuum, but further research is needed.HIGHLIGHTS There is a need for a minimally invasive Alzheimer's disease (AD) diagnostic tool. AD plasma biomarker tests exist at various stages of commercial development. Understanding the development stage of a test is important for its appropriate use. Plasma biomarker tests could function as a triage tool to streamline AD diagnosis. Further steps remain before AD plasma biomarkers can be used routinely.

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Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people

Abstract: Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people. Cochrane Database of Systematic Reviews, 2017(2), [CD012558].

Cited by 8 publications

References 144 publications

Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's

Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's

Clinical judgement of general practitioners: an effective tool in the diagnosis of dementia?

The potential clinical value of plasma biomarkers in Alzheimer's disease

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