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Related Experiment Videos

Implementing a screening and diagnosis program for dementia in primary care.

Malaz Boustani1, Christopher M Callahan, Frederick W Unverzagt

  • 1Indiana University Center for Aging Research, Indianapolis, USA. mboustani@regenstrief.org

Journal of General Internal Medicine
|July 30, 2005
PubMed
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Primary care screening for dementia is feasible but faces challenges. Many patients scoring positive on dementia screening tests do not complete formal diagnosis, indicating practical barriers to care.

Area of Science:

  • Geriatric Medicine
  • Neurology
  • Public Health

Background:

  • Primary care physicians play a crucial role in early dementia detection and management.
  • A comprehensive screening and diagnosis program for dementia in primary care settings was evaluated for feasibility and utility.

Purpose of the Study:

  • To assess the feasibility and utility of a dementia screening and diagnosis program within primary care settings.
  • To determine the prevalence of dementia and related cognitive impairments in an urban, diverse primary care population.

Main Methods:

  • Screening of individuals aged 65 and older across seven urban primary care practices.
  • Dementia diagnosis by an expert panel using ICD-10 criteria, neuropsychological testing, and review of patient/caregiver/medical records.

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Main Results:

  • Out of 3,340 screened patients, 434 scored positive, but only 227 proceeded to formal assessment.
  • Among those assessed, 47% were diagnosed with dementia, 33% with cognitive impairment-no dementia (CIND), and 20% with no cognitive deficit.
  • Estimated dementia prevalence was 6.0%; program cost was $128 per patient screened and $3,983 per diagnosed case. Only 19% of diagnosed dementia cases had prior medical record documentation.

Conclusions:

  • Dementia is prevalent and often undiagnosed in primary care settings.
  • Screening instruments alone lack the specificity for definitive dementia diagnosis in this context.
  • Health system and patient-level barriers hinder the practical implementation of comprehensive dementia diagnosis in primary care, challenging the current standard of care.