Alzheimer News:

Primary Care Physicians Often Fail to Recognize Dementia

Primary care physicians are failing to recognize dementia in older patients at an alarming rate, according to a study reported in the June issue of the Journal of Gerontology: Medical Sciences.

Oregon Health & Science University (OHSU) researchers said their finding suggests that physicians pay more attention to their older patients’ cognitive function, especially those that have experienced adverse events that may signal dementia.

Study co-author Linda Boise, Ph.D., M.P.H., of the OHSU Layton Center for Aging & Alzheimer's Disease Research, said protocols for recognizing dementia symptoms exist, but noted that "doctors just need to use them."

The study involved 553 patients aged 75 and older who were seeing 34 primary care physicians affiliated with three managed health care plans in Portland, Ore. The participants were grouped according to their level of cognitive impairment. The researchers studied their medical charts to determine if they had had any adverse cognitive events and whether they had been examined, diagnosed or treated for dementia in the last three years.

Adverse cognitive events included medication use errors, problems complying with recommended treatments, increased emergency room visits, falls, family contacts with the doctor about a patient's condition, missed appointments or frequent phone calls by the patient to the doctor.

Only 18 percent of mildly impaired patients and 34.8 percent of moderately-to-severely impaired patients were clinically evaluated for dementia. None of the mildly impaired patients and just 4.3 percent of the more severely impaired patients were offered dementia medication.

Nearly two-thirds of the mildly impaired patients and three-fourths of the more impaired individuals experienced one or more adverse events. Of those, only 23.7 percent of the mildly impaired group and 44.2 percent of the moderately-to-severely impaired group was evaluated for dementia.

Study co-author Dr. Jeffrey Kaye, OHSU professor of neurology and director of the Layton Center, said the results show that primary care physicians need to take time to adequately address cognitive problems and that health plans need to develop a reimbursement system that recognizes the value of physicians’ time in detecting and managing cognitive impairment in an aging population.

Boise said a contributing factor could be skepticism among physicians about the benefits of available treatments and the perception that nothing can be done for the patient. She said doctors working in a comprehensive manner with patients and families can do a lot to ensure optimal care and health.

"It is easy to miss mild dementia," Boise said. "Older patients have a number of problems to attend to and they often don't self-report memory problems. And social graces are preserved for a relatively long time over the course of dementia, so the patient might interact appropriately with the doctor. Thus, the doctor might not see anything to be concerned about."

Boise said early assessment could at least help families prepare emotionally for the tension and confusion that comes in a relationship with a loved one with dementia, Boise believes.

"Mostly what we hear from families is that they wish they had known sooner," she said. "The person might be behaving in strange ways, often in ways that put them in the face of harm, such as non-payment of bills and getting lost, and the family doesn't understand why."

Source: Medical Week staff, July 16, 2004