Clinical recognition of dementia and cognitive impairment in primary care: A meta-analysis of physician accuracy

Acta Psychiatrica Scandinavica

Volumn 124, Issue 3, 2011, Pages 165-183

  Mitchell, Alex J ^a,b   Meader, Nicholas ^c   Pentzek, Michael ^d  

^a LEICESTER GENERAL HOSPITAL   (United Kingdom)

^b UNIVERSITY OF LEICESTER   (United Kingdom)

^c National Collaborating Centre for Mental Health   (United Kingdom)

^d HEINRICH HEINE UNIVERSITY   (Germany)

Author keywords

Accuracy; Dementia; Diagnosis; Mild cognitive impairment; Sensitivity

Indexed keywords

CAMBRIDGE MENTAL DISORDERS OF THE ELDERLY EXAMINATION; CLINICAL PRACTICE; COGNITION; COGNITIVE ABILITIES SCREENING INSTRUMENT; CONSORTIUM TO ESTABLISH A REGISTRY FOR ALZHEIMERS DISEASE; DEMENTIA; DIAGNOSTIC ACCURACY; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; DIAGNOSTIC TEST ACCURACY STUDY; DISEASE SEVERITY; GENERAL PRACTITIONER; HUMAN; MEDICAL DECISION MAKING; MEDICAL DOCUMENTATION; META ANALYSIS; MILD COGNITIVE IMPAIRMENT; MINI MENTAL STATE EXAMINATION; PREDICTIVE VALUE; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; REVIEW; SEMI STRUCTURED INTERVIEW; SENSITIVITY AND SPECIFICITY; SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE; TELEPHONE INTERVIEW OF COGNITIVE STATUS;

CLINICAL COMPETENCE; DEMENTIA; EARLY DIAGNOSIS; GENERAL PRACTITIONERS; HUMANS; INTELLIGENCE TESTS; MEDICAL RECORDS, PROBLEM-ORIENTED; MENTAL COMPETENCY; MILD COGNITIVE IMPAIRMENT; PATIENT ACCEPTANCE OF HEALTH CARE; PRIMARY HEALTH CARE; RISK FACTORS; SEVERITY OF ILLNESS INDEX;

EID: 80051665845     PISSN: 0001690X     EISSN: 16000447     Source Type: Journal    
DOI: 10.1111/j.1600-0447.2011.01730.x     Document Type: Review

References (95)

1. Downs M. The role of general practice and the primary care team in dementia diagnosis and management. Int J Geriatr Psychiatry 1996;11:937-942.
2. Adelman RD, Greene MG, Friedmann E. Discussions about cognitive impairment in first medical visits: older patients' perceptions and preferences. Am J Alzheimer Dis Other Demen 2004;19:233-238.
3. Wilkinson D, Stave C, Keohane D et al. The role of general practitioners in the diagnosis and treatment of Alzheimer's disease: a multinational survey. J Int Med Res 2004;32:149-159.
4. National Audit Office. Improving services and support for people with dementia. Report By The Controller And Auditor General | HC 604 Session 2006-2007 | 2007.
5. Wilcock J, Iliffe S, Turner S et al. Concordance with clinical practice guidelines for dementia in general practice. Aging Ment Health 2009;13:155-161.
6. Riedel-Heller SG, Schork A, Matschinger H, Angermeyer MC. The role of referrals in diagnosing dementia at the primary care level. Int Psychogeriatr 1999;11:251-262.
7. Villars H, Oustric S, Andrieu S et al. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging 2010;14:110-120.
8. Bamford C, Lamont S, Eccles M et al. Disclosing a diagnosis of dementia: a systematic review. Int J Geriatr Psychiat 2004;19:151-169.
9. Mitchell AJ. Reluctance to disclose difficult diagnoses: a narrative review comparing communication by psychiatrists and oncologists. J Support Care Cancer 2007;15:819-828.
10. Vernooij-Dassen M, Moniz-Cook E, Woods RT et al. Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. Int J Geriatr Psychiat 2005;20:377-386.
11. Williamson J, Stokoe IH, Gray S et al. Old people at home - their unreported needs. Lancet 1964;i:1117-1120.
12. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Detection and documentation of dementia and delirium in acute geriatric wards. Gen Hosp Psychiatry 2004;26:31-35.
13. Joray S, Wietlisbach V, Büla CJ. Cognitive impairment in elderly medical inpatients detection and associated six-month outcomes. Am J Geriatr Psychiatry 2004;12:639-647.
14. Harwood DMJ, Hope T, Jacoby R. Cognitive impairment in medical inpatients. II: do physicians miss cognitive impairment?. Age Ageing 1997;26:37-39.
15. Facing Dementia (2004) (accessed 19 May 2011).
16. Cattel C, Gambassi G, Sgadari A et al. Correlates of delayed referral for the diagnosis of dementia in an outpatient population. J Gerontol A Biol Sci Med Sci 2000;55:M98-M102.
17. Turner S, Iliffe S, Downs M et al. General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing 2004;33:461-467.
18. Bradford A, Kunik ME, Schulz P et al. Missed and delayed diagnosis of dementia in primary care prevalence and contributing factors. Alzheimer Dis Assoc Disord 1999;23:306-314.
19. Cordery R, Harvey R, Frost C et al. National survey to assess current practices in the diagnosis and management of young people with dementia. Int J Geriatr Psychiat 2002;17:124-127.
20. Cantegreil-Kallen I, Lieberherr D, Garcia A, Cadilhac M, Rigaud A-S, Flahault A. La détection de la maladie d'Alzheimer par le médecin généraliste:résultats d'une enquête préliminaire auprès des médecins du réseau [Detection of alzheimer's disease in general medicine: preliminary results of a Sentinelles general practitioner's network survey]. La Revue de Médecine Interne 2004;25:548-555.
21. Iracleous P, Nie JX, Tracy CS et al. Primary care physicians' attitudes towards cognitive screening: findings from a national postal survey. Int J Geriatr Psychiat 2010;25:23-29.
22. Brodaty H, Howarth GC, Mant A, Kurrle SE. General practice and dementia. A national survey of Australian GPs. Med J Aust 1994;160:10-14.
23. National Audit Office. Improving dementia services in England - an interim report gp survey results. 2010.
24. Ólafsdóttir M, Skoog I, Marcusson J. Detection of dementia in primary care: the Linköping study. Dement Geriatr Cogn Disord 2000;11:223-229.
25. Mitchell AJ. The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. Int J Geriatr Psychiatry 2008;23:1191-1202.
26. Iliffe S, Pealing L. Subjective memory problems. BMJ 2010;340:c1425.
27. Donner-Banzhoff N. Dealing with uncertainty in general medical practice. Z Evid Fortbild Qual Gesundh wesen 2008;102:13-18.
28. Gulbrandsen P, Fugelli P, Hjortdahl P. General practitioners' knowledge of their patients' socioeconomic data and their ability to identify vulnerable groups. Scand J Prim Health Care 1998;16:204-210.
29. Parsons PL. Mental health of Swansea's old folk. Br J Prev Soc Med 1965;19:43-47.
30. Renshaw J, Scurfield P, Cloke L et al. General practitioners' views on the early diagnosis of dementia. Br J Gen Pract 2001;51:37-38.
31. ANAES. Guidelines for diagnosis of Alzheimer's disease. Service des Recommendations et References Professionelles (France), April 12, 2003. Available at. Accessed March 6, 2006.
32. Patterson C, Gauthier S, Bergman H et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Can J Neurol Sci 2001;28(Suppl 1):S3-S16.
33. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, Dekosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.
34. Wind A, Gussekloo J, Vernooij-Dassen M et al. NHG-Standarad dementie (tweede herziening) [Dutch College of General Practitioners Dementia guideline]. Huisarts Wet 2003;46:754-767.
35. Waldemar G, Phung KTT, Burns A et al. on behalf of the European Dementia Consensus Network (EDCON) Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 2007;22:47-54.
36. De Lepeleire J, Wind AW, Iliffe S et al. The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups. Aging Ment Health 2008;12:568-576.
37. Department of Health. Living well with dementia: a National Dementia Strategy, Feb 2009.
38. Van Hout HPJ, Vernooij-Dassen MJ, Stalman WAB. Diagnosing dementia with confidence by GPs. Fam Pract 2007;24:616-621.
39. Millard FB, Thistlethwaite J, Spagnolo C et al. Dementia diagnosis: a pilot randomised controlled trial of education and IT audit to assess change in GP dementia documentation. Aust J Primary Health 2008;14:141-149.
40. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 2009;6:e1000097.
41. Consensus report of the Working Group on Molecular and Biochemical Markers of Alzheimer's Disease. The Ronald and Nancy Reagan Research Institute of the Alzheimer's Association and the National Institute on Aging Working Group. Neurobiol Aging 1998;19:109-116.
42. Reitsma JB, Glas AS, Rutjes AWS et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58:982-990.
43. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
44. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-1101.
45. Ferri CP, Prince M, Brayne C et al. Alzheimer's Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117.
46. Kaduszkiewicz H, Zimmerman T, Van Den Bussche H et al. Do general practitioners recognize mild cognitive impairment in their patients? J Nutr Health Aging 2010;14:697-702.
47. Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000;160:2964-2968.
48. Luck T, Riedel-Heller SG, Kaduszkiewicz H et al. Mild cognitive impairment in general practice: age-specific prevalence and correlate results from the German study on ageing, cognition and dementia in primary care patients (AgeCoDe). Dement Geriatr Cogn Disord 2007;24:307-316.
49. Downs M, Turner S, Bryans M et al. Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. Br Med J 2006;332:692-696.
50. Perry M, Draskovic I, Lucassen P et al. Effects of educational interventions on primary dementia care: a systematic review. Int J Geriatr Psychiat 2011;26:1-11.
51. Pentzek M, Wollny A, Wiese B et al. Apart from Nihilism and Stigma: what influences general practitioners' accuracy in identifying incident dementia? Am J Geriatr Psychiatry 2009;17:965-975.
52. Löppönen M, Räihä I, Isoaho R et al. Diagnosing cognitive impairment and dementia in primary health care - a more active approach is needed. Age Ageing 2003;32:606-612.
53. Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res 2009;43:411-431.
54. Van Den Kommer TN, Bontempo DE, Comijs HC et al. Classification models for early identification of persons at risk for dementia in primary care: an evaluation in a sample aged 80 years and older. Dement Geriatr Cogn Disord 2009;28:567-577.
55. Palmer K, Backman L, Winblad B, Fratiglioni L. Detection of Alzheimer's disease and dementia in the preclinical phase: population based cohort study. BMJ 2003;326:245.
56. Mitchell AJ, Malladi S. Screening and case finding tools for the detection of dementia. Part I: evidence-based meta-analysis of multidomain tests. Am J Geriatr Psychiatry 2010;18:759-782.
57. Mitchell AJ, Malladi S. Screening and case-finding tools for the detection of dementia. part ii: evidence-based meta-analysis of single-domain tests. Am J Geriatr Psychiatry 2010;18:783-800.
58. American Psychological Association. Standards for educational and psychological testing. Washington, DC: American Psychological Association, 1985.
59. Meeuwsen EJ, German P, Melis RJ et al. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial. J Nutr Health Aging 2009;13:242-248.
60. Rishoej S, Waldorff FB, Waldemar G. Why do GPS not refer patients with suspected dementia to memory clinics? Neurobiol Aging, 2004;25(Suppl 2):S104-S105.
61. Eefsting JA, Boersma F, Van Den Brink W, Van Tilburg W. Differences in prevalence of dementia based on community survey and general practitioner recognition. Psychol Med 1996;26:1223-1230.
62. Bamford C, Eccles M, Steen N et al. Can primary care record review facilitate earlier diagnosis of dementia? Fam Pract 2007;24:108-116.
63. Ramakers IH, Visser PJ, Aalten P et al. Symptoms of preclinical dementia in general practice up to five years before dementia diagnosis. Dement Geriatr Cogn Disord 2007;24:300-306.
64. Hinton L, Franz C, Reddy G et al. Practice constraints, behavioural problems and dementia care: primary care physicians perspectives. J Gen Intern Med 2007;22:1625-1627.
65. Cahill S, Clark M, Walsh C, O'connell H, Lawlor B. Dementia in primary care: the first survey of Irish general practitioners. Int J Geriatr Psychiatry 2006;21:319-324.
66. Koch T, Iliffe S. Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Fam Pract 2010;11 Article Number:52.
67. Dale W, Hemmerich J, Hill EK et al. What correlates with the intention to be tested for mild cognitive impairment (MCI) in healthy older adults? Alzheimer Dis Assoc Disord 2008;22:144-152.
68. Boustani M, Callahan CM et al. Implementing a screening and diagnosis program for dementia in primary care. J Gen Intern Med 2005;20:572-577.
69. Boustani M, Perkins AJ, Fox C et al. Who refuses the diagnostic assessment for dementia in primary care? Int J Geriatr Psychiatry 2006;21:556-563.
70. Hansen EC, Hughes C, Routley G et al. General practitioners' experiences and understandings of diagnosing dementia: factors impacting on early diagnosis. Soc Sci Med 2008;67:1776-1783.
71. Bond J, Stave C, Sganga A et al. Inequalities in dementia care across Europe: Key findings of the Facing Dementia Survey. Int J Clin Pract 2005;146:8-14.
72. Waldorff FB, Moller S. Diagnostic evaluation of dementia in general practice in Denmark. A national survey. Scand J Prim Health Care 2001;19:117-121.
73. Kostopoulou O, Delaney BC, Munro CW. Diagnostic difficulty and error in primary care - a systematic review. Fam Pract 2008;25:400-413.
74. Wilkins CH, Wilkins KL, Meisel M, Depke M, Williams J, Edwards DF. Dementia undiagnosed in poor older adults with functional impairment. J Am Geriatr Soc 2007;55:1771-1776.
75. Nourhashemi F, Amouyal-Barkate K, Gilette-Guyonnet S et al. Living alone with Alzheimer's disease: cross-sectional and longitudinal analysis in the REAL.FR study. J Nutr Aging 2005;9:117-120.
76. Chodosh J, Petitti DB, Elliott M et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc 2004;52:1051-1059.
77. Seshadri S, Beiser A, Au R et al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Alzheimer's Dement 2011;7:35-52.
78. Perry M, Draskovic I, Van Achterberg T et al. Development and validation of quality indicators for dementia diagnosis and management in a primary care setting. J Am Geriatr Soc 2010;58:557-563.
79. Perry M, Drasković I, Van Achterberg T et al. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial. BMC Health Serv Res 2008;8:71.
80. Perry M, Melis RJF, Teerenstra S et al. An in-home geriatric programme for vulnerable community-dwelling older people improves the detection of dementia in primary care. Int J Geriatr Psychiat 2008;23:1312-1319.
81. Waldorff FB, Almind G, Mäkelä M et al. Implementation of a clinical dementia guideline. A controlled study on the effect of a multifaceted strategy. Scand J Prim Health Care 2003;21:142-147.
82. Boise L, Neal MB, Kaye J. Dementia assessment in primary care: results from a study in three managed care systems. J Gerontol A Biol Sci Med Sci 2004;59:M621-M626.
83. Borson S, Scanlan JM, Watanabe J, Tu S-P, Lessig M. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry 2006;21:349-355.
84. Bowers J, Jorm AF, Henderson S, Harris P. General practitioners detection of depression and dementia in elderly patients. Med J Aust 1990;153:192-196.
85. Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med 1995;122:422-429.
86. Cooper B, Bickel H, Schäufele M. The ability of general practitioners to detect dementia and cognitive impairment in their elderly patients: a study in Mannheim. Int J Geriatr Psychiatry 1992;7:591-598.
87. Ganguli M, Rodriguez E, Mulsant B et al. Detection and management disease of cognitive impairment in primary care? The Steel Valley Seniors Survey. J Am Geriatr Soc, 2004;52:1668-1675.
88. Iliffe S, Booroff A, Gallivan S, Goldenberg E, Morgan P, Haines A. Screening for cognitive impairment in the elderly using the Mini Mental State Examination. Br J Gen Pract 1990;40:277-279.
89. Jacinto AF, Nitrini R, Brucki SMD. Detection of cognitive impairment in the elderly by general practitioners in Brazil. Alzheimer's Dis 2009;5:P1-P062.
90. Mant A, Eyland EA, Pond CD et al. Recognition of dementia in general practice: comparison of general practitioners' opinions with assessments using the Mini Mental State Examination and the Blessed Dementia Rating Scale. Fam Pract 1988;5:184-188.
91. O'connor DW, Pollitt PA, Hyde JB et al. Do general practitioners miss dementia in elderly patients? BMJ 1988;297:1107-1110.
92. Pond CD, Mant A, Kehoe L et al. General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? Fam Pract 1994;11:141-147.
93. Rondeau V, Allain H, Bakchine S et al. General practice-based intervention for suspecting and detecting dementia in France: a cluster randomized controlled trial. Dementia 2008;7:433.
94. Van Hout H, Vernooij-Dassen M, Poels P et al. Are general practitioners able to accurately diagnose dementia and identify Alzheimer's disease? A comparison with an outpatient memory clinic. Br J Gen Pract 2000;50:311-312.
95. Wind AW, Vanstaveren G, Schellevis FG et al. The validity of the judgment of general-practitioners on dementia. Int J Geriatr Psychiat 1994;9:543-549.