Dutch family physicians’ awareness of cognitive impairment among the elderly

Abstract

BackgroundDementia is often not formally diagnosed in primary care. To what extent this is due to family physicians’ (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs’ awareness of cognitive impairment by comparing their evaluation of the absence or presence of cognitive impairment in older patients without an established diagnosis of dementia, with a reference test of cognitive functioning. In addition, we assessed which patient characteristics were associated with con- and discordance between FPs’ evaluation of cognition and results of the reference test.MethodsThe design was a nested diagnostic study. FPs (n = 29) of 15 primary care practices classified the cognitive status of all their patients ≥ 65 years of age (n = 7865) into four categories, based on recollection and medical records. All patients categorized as ‘possible cognitive impairment or dementia’ and a sample of patients categorized as ‘no signs of cognitive impairment’ randomly selected to match age and gender were offered to receive a reference test of cognitive function (the CAMCOG) to verify the FPs’ label. This reference test could yield three outcomes: no cognitive impairment, amnestic mild cognitive impairment (aMCI) or dementia. Reference test results were weighted back to the original samples to provide estimates for the correct categorization of elderly as ‘possible cognitive impairment or dementia’ (positive predictive value [PPV]) and ‘no signs of cognitive impairment’ (negative predictive value [NPV]). Cognitive functioning was not assessed for patients evaluated by FPs as ‘probable dementia’ and ‘unknown or no recent contact’. Characteristics associated with the con- or discordance of the FPs’ classification and the reference test were assessed using logistic regression.ResultsComplete reference test results were obtained from 318 elderly. FPs labeled 8.3 % of elderly ‘possible cognitive impairment or dementia’. The PPV of this label for a CAMCOG score suggestive of dementia or aMCI was 47.1 % (95 %-confidence interval: 43.5 – 62.4 %). FPs labeled 83.7 % ‘no signs of cognitive impairment’. The 1-NPV of this label for a CAMCOG score suggestive of dementia or aMCI was 12.5 % (95 %-CI 8.2 – 16.8 %). FPs labeled 3.6 % as ‘probable dementia’ and 4.5 % as ‘unknown or no recent contact’. The odds that FPs’ suspicion of cognitive impairment were confirmed by the CAMCOG were higher if persons were ADL dependent (OR 2.24 [95 %-CI 1.16 – 4.35]). The odds of FPs being unaware of the presence of cognitive impairment were higher in the older elderly (OR 1.15 [95 %-CI 1.09 – 1.23] per year).ConclusionEvaluation of FPs’ classification of the global cognitive function of elderly without a firm diagnosis of dementia showed both over- and unawareness of the presence of cognitive impairment. FPs were more often unaware of cognitive impairment in the older elderly.Electronic supplementary materialThe online version of this article (doi:10...

What is the role of the Practice Nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)? : A systematic review.

“…Four studies [23,[26][27][28] evaluated dementia care management in primary health care. Exploring dementia care knowledge and attitudes of primary health care practitioners was the focus of three studies [3,11,12].…”

“…Three studies utilised an RCT [23,27,28] to investigate the impact of collaborative care on quality of life for people with dementia and their caregivers. The study by Van den Dungen et al, [27] also included an evaluation of family practitioner training on diagnosis of mild cognitive impairment.…”

“…Care management ranged in duration from six [28] to twelve months [23,27]. In two studies [27,28] the care managers were registered nurses, with Van den Dungen et al, [27] specifying the nurse as a primary care nurse who acted as the study nurse. In the third study [23] the care manager was a geriatric nurse practitioner.…”

World Federation of Societies of Biological Psychiatry guidelines for the pharmacological treatment of dementias in primary care

“…Hastanın ileride özgür iradesi ile karar veremeyeceği durumlar için, önceden verilen talimatları kapsar. Bu yaşamın sonunda tedavi reddedilmesi olabilir ya da hastanın vesayet ile ilgili beklentileri olabilir (4,16…”

“…Buna göre eşlik eden durum ve komplikasyonların tespiti ve yönetilmesi; bilişsel, duygusal ve davranış yakınmalarının tespit edilmesi; tedavi endikasyonlarının ve tedavi etkilerinin değerlendirilmesi; bakım verenlerin yük ve gereksinimlerinin değerlendirilmesi; bakım ve destek kaynaklarının incelenmesi gibi tedbirlerin alınması beklenmektedir (1). Pratikte ise, aile hekimleri hastalarına ilişkin bilişsel sorunları değerlendirirken bu sorunla ilgili bilgi birikimlerine ya da tutumlarına bağlı kalmaktadırlar (4). Mevcut rehberlerin çoğu demansın tanısı ve yönetimi ile ilgili yönlendirmelerde bulunsalar da aile hekimlerine yönelik hazırlanmış rehberlerin sayıca azlıkları dikkat çekicidir.…”