The pathway to dementia diagnosis

Speechly, Catherine; Bridges‐Webb, C; Passmore, Erin

doi:10.5694/j.1326-5377.2008.tb02140.x

Cited by 95 publications

(97 citation statements)

References 12 publications

(24 reference statements)

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“…(23,27,43–45,47,48) These referrals are not always preceded by adequate diagnostic investigations and/or deemed appropriate by the specialists. (21,23,48–50) Even when dementia is detected and documented in medical charts, PCP seem to withhold the diagnosis in a significant number of cases, and they may fail to follow up with the PWD/caregivers.…”

Section: Resultsmentioning

confidence: 99%

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

et al. 2012

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BackgroundWith the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention.PurposeTo critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care.MethodsAn interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade.ResultsThe current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care.ConclusionsFurther progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

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Section: Resultsmentioning

confidence: 99%

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

et al. 2012

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“…Diagnosis in the early stage of the disease can facilitate patient management Early diagnosis could also allow rapid access to current symptomatic treatments and the implementation of a follow-up plan. Indeed, delays in diagnosis and resource use may have clinical and social implications for patients and their family (33). Without diagnosis, most of these patients are likely to face a number of problems, such as financial loss through errors related to memory problems, poor nutritional intake and weight loss due to difficulties in shopping and cooking related to disabilities on the Instrumental Activities of Daily Living (IADL) (34), errors in the use of medications and increasing risk of iatrogenic events.…”

Section: Detection Of Dementia Symptoms To Improve Early Diagnosis Ofmentioning

confidence: 99%

The primary care physician and Alzheimer's disease: An international position paper

Villars

Oustric

Andrieu

et al. 2010

The Journal of nutrition, health and aging

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This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.

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“…More than 40% of patients with mild dementia are not detected and diagnosed by their healthcare provider [10–14]. In addition, many patients with MCI or early dementia have impaired insight [15] and do not seek early medical intervention, typically only presenting to their family doctor an average of 3–4 years after cognitive symptoms are noticed by others [9, 16, 17]. There are also some family members who explain away the patient’s symptoms, reluctant to accept that their cognitive changes are meaningful.…”

Section: Introductionmentioning

confidence: 99%

Digitally translated Self-Administered Gerocognitive Examination (eSAGE): relationship with its validated paper version, neuropsychological evaluations, and clinical assessments

et al. 2017

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BackgroundThe original paper Self-Administered Gerocognitive Examination (SAGE) is a valid and reliable cognitive assessment tool used to identify individuals with mild cognitive impairment (MCI) or early dementia. We evaluated identical test questions in a digital format (eSAGE) made for tablet use with the goals of calibrating it against SAGE and establishing its association with other neuropsychological tests and clinical assessments of cognitive impairment.MethodsSubjects aged 50 and over who had taken SAGE were recruited from community and clinic settings. Subjects were randomly selected to participate in a clinical evaluation including neuropsychological evaluations. SAGE and eSAGE were administered using a crossover design. Subjects were identified as dementia, MCI, or normal based on standard clinical criteria. Associations were investigated using Spearman correlations, linear regression, and sensitivity and specificity measures.ResultsOf the 426 subjects screened, 66 completed the evaluation. eSAGE score correlation to a battery of neuropsychological tests was 0.73 (p < 0.0001) with no significant difference between the paper and digital format. Spearman correlation of SAGE versus eSAGE was 0.88 (p < 0.0001), and they are related by the formula: eSAGE score = –1.05 + 0.99 × SAGE score. Since the slope is very close to 1 (p = 0.86) there is strong evidence that the scaling is identical between eSAGE and SAGE, with no scale bias. Overall, eSAGE scores are lower by an average of 1.21 and the decrease is statistically significant (p < 0.0001). For those subjects familiar with smartphones or tablets (one measure of digital proficiency), eSAGE scores are lower by an average of 0.83 points (p = 0.029). With a score 16 and higher being classified as normal, eSAGE had 90% specificity and 71% sensitivity in detecting those with cognitive impairment from normal subjects.ConclusionsTablet-based eSAGE shows a strong association with the validated paper SAGE and a neuropsychological battery. It shows no scale bias compared to SAGE. Both have the advantage of self-administration, brevity, four interchangeable forms, and high sensitivity and specificity in detecting cognitive impairment from normal subjects. Their potential widespread availability will be a major factor in overcoming the many obstacles in identifying early cognitive changes.Trial registrationClinicalTrials.gov, NCT02544074. Registered on 18 March 2015.

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The pathway to dementia diagnosis

Cited by 95 publications

References 12 publications

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

The primary care physician and Alzheimer's disease: An international position paper

Digitally translated Self-Administered Gerocognitive Examination (eSAGE): relationship with its validated paper version, neuropsychological evaluations, and clinical assessments

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