Cargando…

Dutch family physicians’ awareness of cognitive impairment among the elderly

BACKGROUND: Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians’ (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs’ awareness o...

Descripción completa

Detalles Bibliográficos
Autores principales: van den Dungen, Pim, Moll van Charante, Eric P., van de Ven, Peter M., Foppes, Gerbrand, van Campen, Jos P. C. M., van Marwijk, Harm W. J., van der Horst, Henriëtte E., van Hout, Hein P. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549900/
https://www.ncbi.nlm.nih.gov/pubmed/26310787
http://dx.doi.org/10.1186/s12877-015-0105-1
_version_ 1782387375194767360
author van den Dungen, Pim
Moll van Charante, Eric P.
van de Ven, Peter M.
Foppes, Gerbrand
van Campen, Jos P. C. M.
van Marwijk, Harm W. J.
van der Horst, Henriëtte E.
van Hout, Hein P. J.
author_facet van den Dungen, Pim
Moll van Charante, Eric P.
van de Ven, Peter M.
Foppes, Gerbrand
van Campen, Jos P. C. M.
van Marwijk, Harm W. J.
van der Horst, Henriëtte E.
van Hout, Hein P. J.
author_sort van den Dungen, Pim
collection PubMed
description BACKGROUND: Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians’ (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs’ awareness of cognitive impairment by comparing their evaluation of the absence or presence of cognitive impairment in older patients without an established diagnosis of dementia, with a reference test of cognitive functioning. In addition, we assessed which patient characteristics were associated with con- and discordance between FPs’ evaluation of cognition and results of the reference test. METHODS: The design was a nested diagnostic study. FPs (n = 29) of 15 primary care practices classified the cognitive status of all their patients ≥ 65 years of age (n = 7865) into four categories, based on recollection and medical records. All patients categorized as ‘possible cognitive impairment or dementia’ and a sample of patients categorized as ‘no signs of cognitive impairment’ randomly selected to match age and gender were offered to receive a reference test of cognitive function (the CAMCOG) to verify the FPs’ label. This reference test could yield three outcomes: no cognitive impairment, amnestic mild cognitive impairment (aMCI) or dementia. Reference test results were weighted back to the original samples to provide estimates for the correct categorization of elderly as ‘possible cognitive impairment or dementia’ (positive predictive value [PPV]) and ‘no signs of cognitive impairment’ (negative predictive value [NPV]). Cognitive functioning was not assessed for patients evaluated by FPs as ‘probable dementia’ and ‘unknown or no recent contact’. Characteristics associated with the con- or discordance of the FPs’ classification and the reference test were assessed using logistic regression. RESULTS: Complete reference test results were obtained from 318 elderly. FPs labeled 8.3 % of elderly ‘possible cognitive impairment or dementia’. The PPV of this label for a CAMCOG score suggestive of dementia or aMCI was 47.1 % (95 %-confidence interval: 43.5 – 62.4 %). FPs labeled 83.7 % ‘no signs of cognitive impairment’. The 1-NPV of this label for a CAMCOG score suggestive of dementia or aMCI was 12.5 % (95 %-CI 8.2 – 16.8 %). FPs labeled 3.6 % as ‘probable dementia’ and 4.5 % as ‘unknown or no recent contact’. The odds that FPs’ suspicion of cognitive impairment were confirmed by the CAMCOG were higher if persons were ADL dependent (OR 2.24 [95 %-CI 1.16 – 4.35]). The odds of FPs being unaware of the presence of cognitive impairment were higher in the older elderly (OR 1.15 [95 %-CI 1.09 – 1.23] per year). CONCLUSION: Evaluation of FPs’ classification of the global cognitive function of elderly without a firm diagnosis of dementia showed both over- and unawareness of the presence of cognitive impairment. FPs were more often unaware of cognitive impairment in the older elderly. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-015-0105-1) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4549900
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-45499002015-08-27 Dutch family physicians’ awareness of cognitive impairment among the elderly van den Dungen, Pim Moll van Charante, Eric P. van de Ven, Peter M. Foppes, Gerbrand van Campen, Jos P. C. M. van Marwijk, Harm W. J. van der Horst, Henriëtte E. van Hout, Hein P. J. BMC Geriatr Research Article BACKGROUND: Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians’ (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs’ awareness of cognitive impairment by comparing their evaluation of the absence or presence of cognitive impairment in older patients without an established diagnosis of dementia, with a reference test of cognitive functioning. In addition, we assessed which patient characteristics were associated with con- and discordance between FPs’ evaluation of cognition and results of the reference test. METHODS: The design was a nested diagnostic study. FPs (n = 29) of 15 primary care practices classified the cognitive status of all their patients ≥ 65 years of age (n = 7865) into four categories, based on recollection and medical records. All patients categorized as ‘possible cognitive impairment or dementia’ and a sample of patients categorized as ‘no signs of cognitive impairment’ randomly selected to match age and gender were offered to receive a reference test of cognitive function (the CAMCOG) to verify the FPs’ label. This reference test could yield three outcomes: no cognitive impairment, amnestic mild cognitive impairment (aMCI) or dementia. Reference test results were weighted back to the original samples to provide estimates for the correct categorization of elderly as ‘possible cognitive impairment or dementia’ (positive predictive value [PPV]) and ‘no signs of cognitive impairment’ (negative predictive value [NPV]). Cognitive functioning was not assessed for patients evaluated by FPs as ‘probable dementia’ and ‘unknown or no recent contact’. Characteristics associated with the con- or discordance of the FPs’ classification and the reference test were assessed using logistic regression. RESULTS: Complete reference test results were obtained from 318 elderly. FPs labeled 8.3 % of elderly ‘possible cognitive impairment or dementia’. The PPV of this label for a CAMCOG score suggestive of dementia or aMCI was 47.1 % (95 %-confidence interval: 43.5 – 62.4 %). FPs labeled 83.7 % ‘no signs of cognitive impairment’. The 1-NPV of this label for a CAMCOG score suggestive of dementia or aMCI was 12.5 % (95 %-CI 8.2 – 16.8 %). FPs labeled 3.6 % as ‘probable dementia’ and 4.5 % as ‘unknown or no recent contact’. The odds that FPs’ suspicion of cognitive impairment were confirmed by the CAMCOG were higher if persons were ADL dependent (OR 2.24 [95 %-CI 1.16 – 4.35]). The odds of FPs being unaware of the presence of cognitive impairment were higher in the older elderly (OR 1.15 [95 %-CI 1.09 – 1.23] per year). CONCLUSION: Evaluation of FPs’ classification of the global cognitive function of elderly without a firm diagnosis of dementia showed both over- and unawareness of the presence of cognitive impairment. FPs were more often unaware of cognitive impairment in the older elderly. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-015-0105-1) contains supplementary material, which is available to authorized users. BioMed Central 2015-08-27 /pmc/articles/PMC4549900/ /pubmed/26310787 http://dx.doi.org/10.1186/s12877-015-0105-1 Text en © van den Dungen et al. 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
van den Dungen, Pim
Moll van Charante, Eric P.
van de Ven, Peter M.
Foppes, Gerbrand
van Campen, Jos P. C. M.
van Marwijk, Harm W. J.
van der Horst, Henriëtte E.
van Hout, Hein P. J.
Dutch family physicians’ awareness of cognitive impairment among the elderly
title Dutch family physicians’ awareness of cognitive impairment among the elderly
title_full Dutch family physicians’ awareness of cognitive impairment among the elderly
title_fullStr Dutch family physicians’ awareness of cognitive impairment among the elderly
title_full_unstemmed Dutch family physicians’ awareness of cognitive impairment among the elderly
title_short Dutch family physicians’ awareness of cognitive impairment among the elderly
title_sort dutch family physicians’ awareness of cognitive impairment among the elderly
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549900/
https://www.ncbi.nlm.nih.gov/pubmed/26310787
http://dx.doi.org/10.1186/s12877-015-0105-1
work_keys_str_mv AT vandendungenpim dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT mollvancharanteericp dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT vandevenpeterm dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT foppesgerbrand dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT vancampenjospcm dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT vanmarwijkharmwj dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT vanderhorsthenriettee dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly
AT vanhoutheinpj dutchfamilyphysiciansawarenessofcognitiveimpairmentamongtheelderly