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Abstract

Management of dementia by family physicians in academic settings.

Canadian Family Physician September 2006, 52 (9) 1108-1109;
Nicholas J G Pimlott
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Karen Siegel
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Malini Persaud
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Susan Slaughter
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Carole Cohen
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Gary Hollingworth
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Sandy Cummings
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Neil Drummond
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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William Dalziel
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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James Sylvius
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Dorothy Pringle
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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Tex Eliasziw
Department of Family and Community Medicine, University of Toronto, Ontario, Canada. nick.pimlott@utoronto.ca
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  1. Nicholas J G Pimlott,
  2. Karen Siegel,
  3. Malini Persaud,
  4. Susan Slaughter,
  5. Carole Cohen,
  6. Gary Hollingworth,
  7. Sandy Cummings,
  8. Neil Drummond,
  9. William Dalziel,
  10. James Sylvius,
  11. Dorothy Pringle and
  12. Tex Eliasziw

    Abstract

    OBJECTIVE To determine what proportion of patients with dementia seen by family physicians are assessed and managed according to the recommendations of the Canadian Consensus Conference on Dementia (CCCD).

    DESIGN Retrospective medical record review.

    SETTING Outpatient services in university-affiliated family practice clinics in Calgary, Alta; Ottawa, Ont; and Toronto, Ont.

    PARTICIPANTS One hundred sixty patients who were diagnosed with dementia between January 1, 2000, and June 1, 2004.

    MAIN OUTCOME MEASURES Use of the Mini-Mental State Examination (MMSE); collateral history; physical examination maneuvers; initial laboratory tests; diagnostic imaging; caregiver identification, assessment, and referral; driving assessment; specialist referral patterns; and other recommendations of the CCCD.

    RESULTS The average age of patients assessed was 83 years; most patients (66.3%) were female. More than half (54.1%) were diagnosed with Alzheimer disease or vascular dementia. More than 25% of patients were not given a specific diagnosis: 13.1% were labeled as "dementia," and 12.5% as "not yet diagnosed." For most patients (69.6%) a collateral history was obtained and a primary caregiver identified (79.4%). Few physicians, however, assessed caregiver stress (33.1%) or referred caregivers for support (12.5%). Most patients (80.6%) seen by their family physicians for cognitive changes underwent at least one MMSE. The average score on the first MMSE was 23.5 (of 30) points. Most physicians ordered appropriate "basic" blood tests as part of their assessment. Forty percent of patients had computed tomographic examinations within 3 months of reporting symptoms of cognitive difficulties to their family physicians. Of these, 25% met the criteria for computed tomographic scan as recommended by the guidelines. Only 36.5% were asked about driving status or safety concerns and had this inquiry documented. Of those, 15.5% were referred for driving evaluations and 12.5% were reported to the Ministry of Transportation.

    CONCLUSION There is fair to good compliance with recommendations of the 1999 CCCD guidelines. There is, however, little assessment of caregiver coping and referral of caregivers for support. Similarly, there is little assessment of driver safety and referral for formal driving evaluations. Computed tomographic imaging as part of the evaluation of dementia is overused.

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    Canadian Family Physician
    Vol. 52, Issue 9
    1 Sep 2006
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    Management of dementia by family physicians in academic settings.
    Nicholas J G Pimlott, Karen Siegel, Malini Persaud, Susan Slaughter, Carole Cohen, Gary Hollingworth, Sandy Cummings, Neil Drummond, William Dalziel, James Sylvius, Dorothy Pringle, Tex Eliasziw
    Canadian Family Physician Sep 2006, 52 (9) 1108-1109;

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    Management of dementia by family physicians in academic settings.
    Nicholas J G Pimlott, Karen Siegel, Malini Persaud, Susan Slaughter, Carole Cohen, Gary Hollingworth, Sandy Cummings, Neil Drummond, William Dalziel, James Sylvius, Dorothy Pringle, Tex Eliasziw
    Canadian Family Physician Sep 2006, 52 (9) 1108-1109;
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