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The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

Objective: Optimising care for dementia patients and their informal carers is imperative in light of the impending dementia epidemic. An important aspect of care is accurate recognition and diagnosis of dementia. The aim of this review was to estimate family physicians' diagnostic accuracy at the different stages of dementia.

Methods: Pubmed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched for articles comparing family physicians' ‘dementia’ and ‘cognitive impairment’ diagnoses in the primary care setting to reference standard dementia diagnoses.

Results: Data from six cross-sectional studies of moderate to reasonable methodological quality were extracted for the analysis. One study considered the accuracy of family physicians' recollecteddiagnoses, and three studies focussed on documented diagnoses. In these four studies, the sensitivity of family physicians' combined diagnostic categories of ‘cognitive impairment’ together with ‘dementia’ was 0.48–0.67 for mild dementia and 0.76–0.85 for moderate to severe dementia. The sensitivity of their diagnostic category ‘dementia’ alone was 0.14–0.33 for mild and 0.28–0.61 for moderate to severe dementia. Specificity was excellent for all severity stages in both comparisons.

Three studies examined the accuracy of family physicians' judgement of cognition during consultation. Compared with the studies on recollection and documentation, these studies reported higher sensitivity and lower specificity.

Conclusion: Many individuals with dementia are not recognised or not diagnosed as such; particularly mild dementia is under-diagnosed. Collaboration within primary care and education focussing both on knowledge and attitude are recommended to improve the accuracy of family physicians' dementia diagnosis. Copyright © 2011 John Wiley & Sons, Ltd.

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Additional Titles
International Journal of Geriatric Psychiatry

Key Information

Type of Reference
Jour
ISBN/ISSN
0885-6230
Resource Database
Cin20 cinahl - exported on 11/7/2016
Publication Year
2012
Issue Number
4
Volume Number
27
Start Page
342-354 13p