Do general practitioners recognize mild cognitive impairment in their patients?
- 179 Downloads
The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population.
Primary care chart registry sample.
3,242 non-demented GP patients aged 75–89 years.
GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard).
The sensitivity of GPs to detect MCI was very low (11–12%) whereas their specificity amounts to 93–94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients’ degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCIdomains were impaired.
The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.
Key wordsMild cognitive impairment recognition primary care early detection dementia
- 19.Zaudig M, Hiller W. SIDAM-Handbuch. Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multi-Infakrt-(oder vaskulären) Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD-10. Verlag Hans Huber: Bern, 1996Google Scholar
- 23.Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and Regression Trees. Wadsworth: Belmont, CA, 1984.Google Scholar
- 24.Luck T, Riedel-Heller SG, Kaduszkiewicz H, Bickel H, Jessen F, Pentzek M 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. DOI: 10.1159/000108099CrossRefPubMedGoogle Scholar
- 25.Brauns H, Steinmann S. Educational Reform in France, West-Germany and the United Kingdom. ZUMA-Nachrichten 1999; 44: 7–44.Google Scholar
- 43.Boustani M, Peterson B, Hanson L et al. Screening for Dementia in Primary Care: A Summary of the Evidence for the U.S. Preventive Task Force. Ann Int Medicine 2003; 138: 927–942.Google Scholar
- 49.Colcombe S, Eriksson E, Scalf P, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol Med Sci 2006; 61A: 1166–1170.Google Scholar