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Primary care and dementia: 1. diagnosis, screening and disclosure
International Journal of Geriatric Psychiatry, 03/02/09

Iliffe S et al. - This study reveals insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care.

Methods

Systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006.
Cochrane Reviews were identified.
Other publications found by consultation with experts.

Results

The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care.
Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians.
Problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems.
Diagnosis is a step-wise process which can be aided by use of cognitive function tests.
Communication skills in talking to people with dementia about dementia can be improved.

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