Primary care service utilisation pattern in dementia: a 10-year longitudinal population-based study.

Area of Science:

• Neurology
• Gerontology
• Public Health

Background:

• Primary care is crucial for dementia management.
• Dementia care patterns differ across subtypes like Alzheimer's disease (AD), vascular dementia (VD), dementia with Lewy bodies (DLB), and Parkinson's disease dementia (PDD).

Purpose of the Study:

• To examine longitudinal factors influencing primary care contact.
• Investigated determinants 5 years before and after diagnosis for AD, VD, DLB, and PDD.
• Included clinical, cognitive, functional, and sociodemographic variables.

Main Methods:

• Retrospective cohort study of 4384 individuals diagnosed between 2008-2023.
• Utilized South London health data linking dementia and primary care records.
• Applied linear mixed-effects models to analyze 3-month contact intervals pre- and post-diagnosis.

Main Results:

• Service utilization increased longitudinally; VD showed a steeper pre-diagnosis rise, PDD moderate post-diagnosis increases versus AD.
• Worse cognition and antipsychotic use correlated with lower contact; older age and Black/British Black ethnicity with higher contact.
• Pre-diagnosis: agitation, mood/living problems linked to lower contact; hallucinations to higher. Post-diagnosis: hypnotic/anxiolytic use predicted lower contact; acetylcholinesterase inhibitors, comorbidities, daily living issues, and mixed ethnicity associated with increased use.

Conclusions:

• Care pathways must account for dementia subtype-specific and individual contact patterns.
• Targeted support is needed for individuals with reduced pre-diagnosis contact, indicating potential unmet needs.
• Early intervention strategies should consider groups likely to need increased post-diagnosis services.