Overdiagnosis of Dementia in Young Patients – A Nationwide Register-Based Study

Salem, Lise Cronberg; Andersen, Birgitte; Nielsen, T. Rune; Stokholm, Jette; Jørgensen, Martin Balslev; Rasmussen, Morten; Waldemar, Gunhild

doi:10.1159/000345485

Cited by 64 publications

(61 citation statements)

References 20 publications

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“…Individuals with dementia were identified as those who had been registered with a dementia diagnosis (in the National Patient Registry or Psychiatric Central Research Registry) as the main or secondary diagnosis during admission or at an outpatient visit (ICD-8 codes: 290.10, 293.09-19, 290.11, 290.09-19; ICD-10 codes: F00.0, F00.1, F00.2, F00.9, F01.0, F01.1, F01.2, F01.3, F01.8, F01.9, F02.0, F03, G30.0, G30.1, G30.8, G30.9, G31.8, G31.9) and/or who had filled in a prescription for an antidementia drug (ATC: N06D) before the date of admission for the hip fracture. The individuals had to be ≥60 years at the time of the dementia diagnosis and/or first prescription, since the validity of diagnoses before that age has been shown to be low [26]. The remaining individuals formed the group without dementia.…”

Section: Methodsmentioning

confidence: 99%

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

Jensen‐Dahm

Palm

Gasse

et al. 2016

Dement Geriatr Cogn Disord

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Background/Aims: Prior studies have shown that patients with dementia are at risk of receiving insufficient treatment for pain after a hip fracture. We therefore hypothesized that elderly hip fracture patients with dementia received less postoperative pain treatment than those without dementia. Method: All patients (age ≥65 years) who had been operated on for a hip fracture in the Copenhagen University Hospital region in 2009 were included. Data about analgesic use for the first 72 h after surgery were acquired from the hospitals' electronic medication system and linked with information about dementia, comorbidity, and prior drug use. Results: A total of 1,507 patients were included, of which 296 (19.6%) suffered from dementia. Both groups were equally likely to receive paracetamol and opioids. Patients with dementia received lower doses of oral morphine equivalents during the first [dementia vs. no dementia: 29.0 (26.4-31.8) vs. 34.7 (33.1-36.4) mg, p = 0.001] and second [27.8 (25.4-30.5) vs. 31.2 (29.9-32.4) mg, p = 0.019] but not on the third postoperative day (p = 0.10). Conclusion: The lower doses of opioids may reflect uncertainty about how to treat pain patients with dementia. Further guidance is needed, as inadequate treatment of pain may have adverse consequences.

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Section: Methodsmentioning

confidence: 99%

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

Jensen‐Dahm

Palm

Gasse

et al. 2016

Dement Geriatr Cogn Disord

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“…Overdiagnosis of dementia may occur in patients who exhibit subjective cognitive symptoms during an acute or elective admission to a hospital, which may lead the clinician to suspect dementia. This issue was described in our previous study, demonstrating that only 58% of dementia diagnoses in young patients registered in the Danish national hospital registers were correct [9]. Hence, the remaining 42% of the dementia diagnoses were found to be invalid by the raters.…”

Section: Discussionmentioning

confidence: 86%

“…Furthermore, the Danish national registers were used to examine the validity of dementia diagnoses in a population of patients aged ≤65 years registered with a diagnosis of dementia in 2008 [9]. Taken together, our results suggest that dementia is overdiagnosed and overregistered in young patients.…”

Section: Introductionmentioning

confidence: 78%

“…The validity of the dementia diagnosis in our 200 randomly selected patients from the hospital registers was evaluated in a previous publication [9]. Briefly, guided by the quality of clinical information about the diagnostic work-up in the medical records it was determined whether dementia and dementia subtypes could be confirmed according to diagnostic criteria [9,12,13,14,15].…”

Section: Methodsmentioning

confidence: 99%

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Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia: A Nationwide Register-Based Study

Salem

Andersen

Nielsen

et al. 2014

Dement Geriatr Cogn Disord Extra

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Background: Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. Methods: Two hundred patients were randomly selected from 891 patients aged ≤65 years registered with a diagnosis of dementia for the first time in 2008 in Danish hospitals, and 159 medical records were available for review. Three raters evaluated their medical records for the completeness of the diagnostic work-up on which the diagnosis of dementia had been based, using evidence-based guidelines for the diagnostic evaluation of dementia as reference standards. Results: According to the rater review, only 111 (70%) patients met the clinical criteria for dementia. An acceptable diagnostic work-up including all items of recommended basic diagnostic evaluation was performed in only 24%, although more often (28%) in the subgroup of patients where dementia was confirmed by raters. Conclusion: This first nationwide study of unselected young patients registered with a diagnosis of dementia indicated that the concept of dementia may be misinterpreted by clinicians and that a diagnosis of dementia in the young is only rarely based on a complete basic diagnostic work-up, calling for increased competency.

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“…Patients with a dementia diagnosis were identified as those who had been registered with a dementia diagnosis in the National Patient Registry or Psychiatric Central Research Registry before January 1, 2012, during admission or at an outpatient visit and/or those who had filled an anti-dementia drug prescription (ATC: N06D). The individuals had to be ≥60 years at the time of the dementia diagnosis and/or first prescription because the validity of the diagnosis in those <60 years has been shown to be low [22]. The validity of registered dementia diagnoses in those ≥65 years, in contrast, has previously been shown to be high [23].…”

Section: Study Populationmentioning

confidence: 99%

Geographical Variation in Antipsychotic Drug Use in Elderly Patients with Dementia: A Nationwide Study

Zakarias

Jensen‐Dahm

Nørgaard

et al. 2016

JAD

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Abstract.Background: Use of antipsychotics in elderly patients with dementia has decreased in the past decade due to safety regulations; however use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management of behavioral symptoms. Objective: To investigate potential geographical variances in use of antipsychotic drugs in dementia care. Methods: A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n = 34,536) and without (n = 931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, adjusted for age and sex. Results: In 2012, the national prevalence of antipsychotic drug use was 20.7% for elderly patients with dementia, with a national incidence of 3.9%. The prevalence ranged from 17.0% to 23.3% in the five regions and from 7.5% to 33.1% in the 98 municipalities, demonstrating an over four-fold difference. Conclusion: The observed geographical variation was more pronounced at municipal level as compared to regional level, suggesting that the variation may be related to variances in clinical practice in primary care. This study highlights an urgent need for further educating professional carers and physicians to guide non-pharmacological as well as pharmacological management of neuropsychiatric symptoms in elderly patients with dementia.

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Overdiagnosis of Dementia in Young Patients – A Nationwide Register-Based Study

Cited by 64 publications

References 20 publications

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia: A Nationwide Register-Based Study

Geographical Variation in Antipsychotic Drug Use in Elderly Patients with Dementia: A Nationwide Study

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