Can primary care record review facilitate earlier diagnosis of dementia?

Background. There is concern over delayed diagnosis of dementia in primary care. Objective. To determine whether primary care record review can facilitate earlier diagnosis of dementia. Methods. Retrospective notes-based case-control study. Older people with dementia (cases) were identified through older age psychiatrists in the north-east of England. Age- and sex-matched controls were identified in primary care. Frequency and place of consultations, symptoms, presentation, tests and investigations, management, referrals and selected prescription data during the 5 years prior to the diagnosis of dementia were recorded. Results. Relevant symptoms, involvement of family members, unpredictable consulting patterns and problems with management were more likely to be recorded in the notes of cases than controls. Key variables predicting subsequent diagnosis of dementia included the absence of nurse and outpatient consultations and the presence of cognitive symptoms, consultations with primary care physicians and referral for clarification of diagnosis or management. Regression models were better at predicting cases (sensitivity = 80.2%) than controls (specificity = 69.8%). Applying the models to a typical primary care physician's list would result in the identification of 93 false positives in order to identify two new cases 18 months earlier than currently occurs. Conclusions. Differences in consultation patterns can be observed up to 4 years prior to formal diagnosis of dementia, indicating that primary care physicians are attending to possible signs of early dementia. However, it is not practicable to use the systematic review of primary care records to facilitate earlier diagnosis without identifying large numbers of false positives requiring investigation.