Implementing a screening and diagnosis program for dementia in primary care
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BACKGROUND: Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care.
METHODS: We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records.
RESULTS: Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment—no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record.
CONCLUSIONS: Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.
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- Implementing a screening and diagnosis program for dementia in primary care
Journal of General Internal Medicine
Volume 20, Issue 7 , pp 572-577
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cognitive impairment
- primary care
- vulnerable adult
- Industry Sectors
- Author Affiliations
- 1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
- 2. Regenstrief Institute, Inc., 1050 Wishard Blvd., RG6, 46202-2872, Indianapolis, IN
- 3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind, USA
- 4. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Ind, USA