Early dementia ‘missed’ by UK general practitioners
MedWire News: General practitioners (GPs) in the UK are able to accurately identify three-quarters of patients with dementia, but the diagnostic accuracy and recording of early and mild dementia cases varies considerably, shows research from the University of Leicester.
"GPs working in busy settings struggle to identify early dementia and prodromal conditions based on their initial clinical judgement," said the lead researcher.
Among 12,277 individuals enrolled in studies that evaluated cognitive impairment via interviews and cognitive tests, GPs only accurately identified mild cognitive impairment (MCI) - a potential precursor of dementia - in 45% of cases.
GPs accurately identified 73% of individuals with dementia and 76% of those without; however, only 38% of medical records correctly reflected this, write Alex Mitchell (Leicester Partnership Trust) and colleagues in the journal Acta Psychiatrica Scandinavica.
Mild dementia diagnoses were correctly recorded in just 11% of the associated medical notes.
"From these results, we can estimate that about one in four cases of dementia remains undetected even in those seeking help, and this could be as high as one in two people with mild dementia or MCI," they say, speculating that GPs acting alone should not be expected to reliably and routinely diagnose dementia.
GPs' ability to accurately identify individuals with and without MCI (defined by interview) also varied, with specificities of between 87% using clinical opinion, and 96% using medical notation, the researchers report.
However, GPs only actually recognised about 45% of MCI cases overall.
Of note, severity was the main predictor of an accurate diagnosis; for mild dementia, the sensitivity of a physician diagnosis was 45% using clinical judgement while for moderate-severe dementia, it was 81%. Using medical notes, the sensitivity of a mild dementia diagnosis was 40%, but for moderate-severe cases it was 61%.
Mitchell commented that the finding of missed early dementia was particularly apparent among patients living alone, where no informant was available and when patients had relatively preserved daily function.
Improving on unassisted clinical judgement in primary care requires either "more training, more organisational support, or more extensive cognitive testing," conclude the researchers.
However, they accept that GPs are probably no less successful than other non-specialists "and have been hampered by a lack of consensus about which cognitive screening tools are most appropriate."
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By Sarah Guy