The journal of nutrition, health & aging

, Volume 16, Issue 5, pp 462–467 | Cite as

Assessment and management of patients with cognitive impairment and dementia in primary care

  • Joël Belmin
  • L. Min
  • C. Roth
  • D. Reuben
  • N. Wenger



To evaluate care provided by primary care physicians in community practice to older patients presenting with cognitive impairment and dementia.


Secondary analysis of an intervention study.


Primary care clinics.


101 patients 75 years and older enrolled in the ACOVE-2 study who presented with a new cognitive problem, new dementia, or prevalent dementia.


Patients assessment and management were evaluated from medical record review and caregiver interviews.


Among 34 patients presenting with a new cognitive problem, half received a cognitive assessment comprising of a test of memory and one other cognitive task, 41% were screened for depression and 29% were referred to a consultant. Of the 27 patients with newly diagnosed dementia, 15% received the components of a basic neurological examination, one-fifth received basic laboratory testing and for one third the medical record reflected an attempt to classify the type of dementia. Counseling was under-reported in the medical record compared to the caregiver interview for the 101 patients with dementia, but even the interview revealed that about half or fewer patients received counseling about safety and accident prevention, caregiver support or managing conflicts. Less than 10% were referred to a social worker.


This small but detailed evaluation suggests patients presenting with cognitive problems to primary care physicians do not consistently receive basic diagnosis and management.

Key words

Primary care dementia cognitive impairment 


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  1. 1.
    Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population:prevalence estimates using the 2000 census. Arch Neurol. 2003;60:1119–1122.PubMedCrossRefGoogle Scholar
  2. 2.
    Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe:a collaborative study of population-based cohorts, Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(suppl 5):S4–S9.PubMedGoogle Scholar
  3. 3.
    Cummings JL. Alzheimer’s disease. N Engl J Med. 2004 1;351:56–67.Google Scholar
  4. 4.
    Pimlott NJ, Siegel K, Persaud M et al. Management of dementia by family physicians in academic settings. Can Fam Physician. 2006;52:1108–1109.PubMedGoogle Scholar
  5. 5.
    Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA 1997;278:1363–1371.PubMedCrossRefGoogle Scholar
  6. 6.
    Cummings JL, Frank JC, Cherry D et al. Guidelines for managing Alzheimer’s disease: part I. Assessment. Am Fam Physician. 2002;65:2263–2272.PubMedGoogle Scholar
  7. 7.
    Cummings JL, Frank JC, Cherry D et al. Guidelines for managing Alzheimer’s disease: part II. Treatment. Am Fam Physician. 2002;65:2525–2534.PubMedGoogle Scholar
  8. 8.
    Rabins PV, Blacker D, Rovner BW et al; APA Work Group on Alzheimer’s Disease and other Dementias. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry. 2007;164(12 Suppl):5–56.PubMedGoogle Scholar
  9. 9.
    Waldemar G, Dubois B, Emre M, et al; EFNS. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol. 2007;14:1–26.CrossRefGoogle Scholar
  10. 10.
    Brayne C, Fox C, Boustani M. Dementia screening in primary care: is it time? JAMA. 2007;298:2409–2411.PubMedCrossRefGoogle Scholar
  11. 11.
    Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160:2964–2968.PubMedCrossRefGoogle Scholar
  12. 12.
    Olafsdottir M, Skoog I, Marcusson J. Detection of dementia in primary care: the Linkoping Study. Dement Geriatr Cogn Disord. 2000;11:223–229.PubMedCrossRefGoogle Scholar
  13. 13.
    Larson EB. Management of Alzheimer’s disease in a primary care setting. Am J Geriatr Psychiatry. 1998;6:S34–S40.PubMedCrossRefGoogle Scholar
  14. 14.
    Turner S, Ilife S, Downs M et al. General practitioners’ knowledge, confidence and attitudes in diagnosis and management of dementia. Age Ageing. 2004;33:461–467.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    Cahill S, Clarck 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Rosen CS, Chow HC, Greenbaum MA et al. How well are clinicians following dementia practice guidelines? Alzheimer Dis Assoc Disord. 2002;16:15–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Fortinsky RH, Leighton A, Wasson JH. Primary care physicians’ diagnostic, management, and referral practices for older persons and families affected by dementia. Res Ageing 1995;17:124–148.CrossRefGoogle Scholar
  19. 19.
    Ganguli M, Rodriguez E, Mulsant B et al. Detection and management of cognitive impairment in primary care: the Steel Valley Seniors Survey. J Am Geriatr Soc 2004;52:1668–1675.PubMedCrossRefGoogle Scholar
  20. 20.
    Vickrey BG, Mittman BS, Connor KI et al. The effect of a disease management intervention on quality and outcomes of dementia care. Ann Intern Med 2006;145:713–726.PubMedGoogle Scholar
  21. 21.
    Wenger NS, Roth CP, Shekelle PG et al. A practice-based intervention to improve primary care for falls, incontinence and dementia. J Am Geriatr Soc. 2009; 57: 547–555.PubMedCrossRefGoogle Scholar
  22. 22.
    Wenger NS, Roth CP, Shekelle P; ACOVE Investigators. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc. 2007;55(Suppl 2):S247–S252.PubMedCrossRefGoogle Scholar
  23. 23.
    Weytingh MD, Bossuyt PM, van Crevel H. Reversible dementia: more than 10% or less than 1%? A quantitative review. J Neurol. 1995;242:466–471.PubMedCrossRefGoogle Scholar
  24. 24.
    Clarfield AM. The decreasing prevalence of reversible dementias: an updated metaanalysis. Arch Intern Med. 2003;163:2219–2229.PubMedCrossRefGoogle Scholar
  25. 25.
    Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006;67:1592–1599.PubMedCrossRefGoogle Scholar
  26. 26.
    Pinquart M, Sörensen S. Helping caregivers of persons with dementia: which interventions work and how large are their effects? Int Psychogeriatr. 2006;18:577–595.PubMedCrossRefGoogle Scholar
  27. 27.
    Alzheimer’s Disease and Related Disorders Association. Ethical considerations: issues in death and dying. Chicago, IL: Alzheimer’s Disease and Related Disorders Association;1997. 103.Google Scholar
  28. 28.
    Gjerdingen DK, Neff JA, Wang M, Chaloner K. Older persons’ opinions about lifesustaining procedures in the face of dementia. Arch Fam Med. 1999;8:421–425PubMedCrossRefGoogle Scholar
  29. 29.
    Degenholtz HB, Rhee Y, Arnold RM. The relationship between having a living will and dying in place. Ann Intern Med. 2004;141:113–117.PubMedGoogle Scholar
  30. 30.
    Van Hout H, Vernooij-Dassen M, Bakker K, Blom M, Grol R. General practitioners on dementia: tasks, practices and obstacles. Patient Educ Couns. 2000;39:219–225.PubMedCrossRefGoogle Scholar
  31. 31.
    Covinsky KE, Jonhson CB. Envisioning better approaches for dementia care. Ann Intern Med. 2006;145:780–781.PubMedGoogle Scholar
  32. 32.
    England E. Improving the management of dementia. Simple educational initiatives for primary care are not enough. BMJ. 2006;332:681–682.PubMedCrossRefGoogle Scholar
  33. 33.
    Downs M, Turner S, Bryans M et al. Effectiveness of educational inteventions in improving detection and management of dementia in primary care: cluster randomized controlled study. BMJ 2006:332:692–696.PubMedCrossRefGoogle Scholar
  34. 34.
    Callahan CM, Boustani MA, Unverzagt FW et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care. JAMA. 2006;295:2148–2157.PubMedCrossRefGoogle Scholar
  35. 35.
    Moniz-Cook E, Woods RT. The role of memory clinics and psychosocial intervention in early stages of dementia. Int J Geriatr Psychiatry. 1997;12:1143–1145.PubMedCrossRefGoogle Scholar
  36. 36.
    Aupperle PM, Coyne AC. Primary vs subspecialty care: a structured follow-up of dementia patients and their caregivers. Am J Geriatr Psychiatry. 2000;8:167–170.PubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2012

Authors and Affiliations

  • Joël Belmin
    • 1
    • 5
  • L. Min
    • 2
  • C. Roth
    • 3
  • D. Reuben
    • 2
  • N. Wenger
    • 3
    • 4
  1. 1.Department of GeriatricsHôpital Charles Foix et Université UPMC-Paris 6Ivry-sur-SeineFrance
  2. 2.Division of Geriatrics, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesUSA
  3. 3.RAND HealthSanta MonicaUSA
  4. 4.Division of General Internal Medicine and Health Services Research, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesUSA
  5. 5.Department of GeriatricsHôpital Charles Foix et Université UPMC-Paris 6Ivry-sur-SeineFrance

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