Early diagnosis of dementia in primary care: a representative eight‐year follow‐up study in Lower Saxony, Germany

Maeck, Lienhard; Haak, Sebastian; Knoblauch, Anita; Stoppe, Gabriela

doi:10.1002/gps.1646

Cited by 25 publications

(28 citation statements)

References 24 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This will allow the sub-typing of dementia that is important for both prognosis and treatment, particularly because of tendencies to under-diagnose Alzheimer's disease (Maeck et al, 2007), the only one of the dementias where symptom-modification with medication is possible. Memory clinics are increasingly being established as specialist centres for such assessments (NICE/SCIE, 2006).…”

Section: Confirmation Of a Dementia Diagnosis And The Underlying Pathmentioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

167

154

View full text Add to dashboard Cite

SUMMARYObjectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community. Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia. Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required.

show abstract

Section: Confirmation Of a Dementia Diagnosis And The Underlying Pathmentioning

confidence: 99%

Primary care and dementia: 1. diagnosis, screening and disclosure

Iliffe

Robinson

Brayne

et al. 2009

Int J Geriat Psychiatry

167

154

View full text Add to dashboard Cite

show abstract

“…Among others, we could demonstrate a considerable underdiagnosis of dementia in 1993 [16] . At follow-up in 2001, dementia was considered significantly more often; however, we found a persisting overestimation of vascular aetiology and underdiagnosis of probable DAT [17] .…”

Section: Discussionmentioning

confidence: 56%

“…FPs' diagnoses with respect to both sample case histories have been previously discussed [17] . In summary, we found a prevailing vascular concept of dementia genesis as well as a tendency of underdiagnosing probable DAT (cases 1a/1b: DAT: 11.0% in 1993 vs. 26.2% in 2001; vascular dementia: 2.1% in 1993 vs. 17.2% in 2001).…”

Section: Resultsmentioning

confidence: 99%

“…In the following, methodological proceedings will not be subject of discussion in detail, as they have been delineated earlier [16][17][18][19] . Employing standardized case vignettes in a personal interview results in high participation rates, and, as long as the study focus is blinded as well as possible, allows to reliably re-investigate changes in time course [22] .…”

Section: Discussionmentioning

confidence: 99%

“…The detailed methods as well as the text of the applied sample case histories have been published recently [17] . According to the list of physicians obtained by the Board of Physicians of Lower Saxony, 2 trained investigators (A.K.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Dementia Diagnostics in Primary Care: A Representative 8-Year Follow-Up Study in Lower Saxony, Germany

Maeck

Haak

Knoblauch

et al. 2007

Dement Geriatr Cogn Disord

Self Cite

View full text Add to dashboard Cite

Aim: To investigate whether primary-care physicians’ competency regarding dementia diagnostics improved from 1993 to 2001. Methods: In a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) were randomly assigned to 2 written case samples presenting patients with slight memory impairment (case 1a: female vs. case 1b: male) and moderate dementia [vascular type (case 2a) vs. Alzheimer’s disease (case 2b)]. Potential diagnostic workup was inquired by a structured face-to-face interview. Results: ‘Basic’ diagnostics like history taking or laboratory investigations were considered in the first place. In case 1, neuropsychological screening was significantly more frequently considered at follow-up (19.3% in 1993 vs. 31.1% in 2001); it still would have been applied rarely in case 2 (2a: 14.1 vs. 14.8%; 2b: 23.5 vs. 24.6%). Neuroimaging remained not to be considered as a standard procedure, and only a minority of FPs would have performed a screening for depression (2001: 1a: 6.7%; 1b: 11.3%; 2a: 0.0%; 2b: 1.6%). Conclusions: With regard to dementia diagnostics in primary care, guideline adherence remained low at follow-up. Structured training efforts aiming at FPs appear to be necessary.

show abstract

Current awareness in geriatric psychiatry

2007

Int J Geriat Psychiatry

View full text Add to dashboard Cite

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Reviews; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

show abstract

Early diagnosis of dementia in primary care: a representative eight‐year follow‐up study in Lower Saxony, Germany

Abstract: Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care.

Cited by 25 publications

References 24 publications

Primary care and dementia: 1. diagnosis, screening and disclosure

Primary care and dementia: 1. diagnosis, screening and disclosure

Dementia Diagnostics in Primary Care: A Representative 8-Year Follow-Up Study in Lower Saxony, Germany

Current awareness in geriatric psychiatry

Contact Info

Product

Resources

About