Practical Guidelines for the Recognition and Diagnosis of Dementia

Abstract

To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver sta- Dementia: an OverviewAlzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of all cases, 1,2 and it is therefore the main focus of this article. AD destroys brain cells, causing problems with memory, thinking, and behavior severe enough to affect work, family, and social relationships and, eventually, the most basic activities of daily living (ADLs). AD and related disorders are a growing public health problem in the United States, with a prevalence ranging from 3% to 11% among people aged 65 years and older and from 25% to 47% among those aged older than 85 years. 3,4 There are an estimated 5.3 million cases of dementia in the United States, 5 and this number is expected to increase to 18.5 million by 2050. 6 The number of those afflicted is increasing annually as a result of the aging population. Dementia leads to a high burden of suffering for patients, families, and society, with an annual estimated cost of $172 billion. 5 People with dementia usually present first to their family physician, although an estimated 39% present to specialist clinics (neurologists, psychiatrists and geriatricians). 7 The primary care physician (PCP) is often the first physician to observe patients with possible dementia and often the only physician involved in making the diagnosis. 8 Because of the key role that PCPs play in the longterm management of elderly individuals with chronic disease, the growing number of patients with dementia will have a significant impact on these health professionals. 9 The rising number of patients with dementia means that family physicians will have an increasingly important role in recognizing early signs and symptoms of disease, ordering appropriate tests, formally diagnosing, and, finally, treating these patients. However, at present, diagnosing AD can be Funding: none. Conflict of interest:Dr Sadowsky has served as a consultant to Novartis Pharmaceuticals Corporation, has served as a speaker for Novartis Pharmaceuticals Corporation and Forest Pharmaceuticals and Accera, and has received honoraria from these companies. James E Galvin is a paid consultant for ...

Dementia Approach and Follow-up in Primary Care

“…Many caregivers are the same age or even older and consideration should be given to caregivers themselves as patients also. They are at increased risk of depression and physical illness, such as, cardiovascular and respiratory diseases and blood pressure (Galvin et al, 2012;Norma da DGS nº 053/2011). In addition to research into distress signals (complaints of stress, sleep disturbance and others), overload, or psychiatric symptoms, caregiver assessment should also focus on their knowledge about the disease, expectations of treatment and services, quality of the patient-caregiver relationship and family conflicts (Boustani et al, 2007;Norma da DGS nº 053/2011).…”

“…In addition to research into distress signals (complaints of stress, sleep disturbance and others), overload, or psychiatric symptoms, caregiver assessment should also focus on their knowledge about the disease, expectations of treatment and services, quality of the patient-caregiver relationship and family conflicts (Boustani et al, 2007;Norma da DGS nº 053/2011). Evaluating the caregiver's health status can lead to the implementing measures to minimize patient/caregiver conflict and allow delaying patient institutionalization (Galvin et al, 2012).…”

“…), psychiatric disorders (depression), infectious diseases (syphilis, HIV infection, etc. ), endocrine-metabolic diseases (hypothyroidism); history of head injury; medication; alcohol, smoking and toxicological habits as well as previous surgeries (Alves & Caetano, 2010;Galvin et al, 2012;Pinho, 2008). Age is the main risk factor for dementia.…”

“…The incidence and prevalence of dementia increases with age, doubling approximately every 5 years after age 65, such that a value of 0.8% in the age group from 65 to 69 years increases to 28.5% over the age of 90 years (Pinho, 2008). The family physician is often the first physician the patient with suspected dementia turns to, although approximately 39% resort to other specialists, including neurologists or psychiatrists (Galvin & Sadowsky, 2012;Samsi & Manthorpe, 2014). Primary health care services (PHC) represent patients' first level of access to the National Health System.…”

As queixas subjetivas de memória num cuidado de saúde primário: Um estudo follow up

“…Essas queixas são expressas por pessoas adultas com 55 ou mais anos, embora sejam particularmente comuns em pessoas idosas (Açikgöz et al, 2014;Eichler et al, 2015;Galvin & Sadowsky, 2012;Ginó et al, 2010;Iliffe et al, 2002;Mendes et al, 2008;Mendonça, Alves, & Bugalho, 2016;Pais, 2008;Pires et al, 2012).…”