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Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews

BACKGROUND: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. METHODS: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Review...

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Autores principales: Fernandes, Brooklynn, Goodarzi, Zahra, Holroyd-Leduc, Jayna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359121/
https://www.ncbi.nlm.nih.gov/pubmed/34380424
http://dx.doi.org/10.1186/s12875-021-01461-5
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author Fernandes, Brooklynn
Goodarzi, Zahra
Holroyd-Leduc, Jayna
author_facet Fernandes, Brooklynn
Goodarzi, Zahra
Holroyd-Leduc, Jayna
author_sort Fernandes, Brooklynn
collection PubMed
description BACKGROUND: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. METHODS: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. RESULTS: Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. CONCLUSIONS: There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-021-01461-5.
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spelling pubmed-83591212021-08-16 Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews Fernandes, Brooklynn Goodarzi, Zahra Holroyd-Leduc, Jayna BMC Fam Pract Research BACKGROUND: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. METHODS: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. RESULTS: Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. CONCLUSIONS: There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-021-01461-5. BioMed Central 2021-08-11 /pmc/articles/PMC8359121/ /pubmed/34380424 http://dx.doi.org/10.1186/s12875-021-01461-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Fernandes, Brooklynn
Goodarzi, Zahra
Holroyd-Leduc, Jayna
Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title_full Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title_fullStr Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title_full_unstemmed Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title_short Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
title_sort optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359121/
https://www.ncbi.nlm.nih.gov/pubmed/34380424
http://dx.doi.org/10.1186/s12875-021-01461-5
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