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Implementing a screening and diagnosis program for dementia in primary care

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Abstract

BACKGROUND: Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care.

METHODS: We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records.

RESULTS: Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment—no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record.

CONCLUSIONS: Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.

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Authors and Affiliations

  1. Indiana University Center for Aging Research, Indianapolis, Ind, USA

    Malaz Boustani MD, MPH, Christopher M. Callahan MD, Anthony J. Perkins MS, Bridget A. Fultz MA, Siu L. Hui PhD & Hugh C. Hendrie MB, ChB

  2. Regenstrief Institute, Inc., 1050 Wishard Blvd., RG6, 46202-2872, Indianapolis, IN

    Malaz Boustani MD, MPH, Christopher M. Callahan MD, Anthony J. Perkins MS, Bridget A. Fultz MA, Siu L. Hui PhD & Hugh C. Hendrie MB, ChB

  3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind, USA

    Malaz Boustani MD, MPH, Christopher M. Callahan MD & Siu L. Hui PhD

  4. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Ind, USA

    Frederick W. Unverzagt PhD, Mary G. Austrom PhD & Hugh C. Hendrie MB, ChB

Authors
  1. Malaz Boustani MD, MPH
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  2. Christopher M. Callahan MD
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  3. Frederick W. Unverzagt PhD
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  4. Mary G. Austrom PhD
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  5. Anthony J. Perkins MS
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  6. Bridget A. Fultz MA
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  7. Siu L. Hui PhD
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  8. Hugh C. Hendrie MB, ChB
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Corresponding author

Correspondence to Malaz Boustani MD, MPH.

Additional information

Supported by grant R01 HS10884-01 from the Agency for Healthcare Research and Quality.

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Boustani, M., Callahan, C.M., Unverzagt, F.W. et al. Implementing a screening and diagnosis program for dementia in primary care. J GEN INTERN MED 20, 572–577 (2005). https://doi.org/10.1007/s11606-005-0103-7

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  • DOI: https://doi.org/10.1007/s11606-005-0103-7

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