The detection of dementia in the primary care setting

被引:350
作者
Valcour, VG
Masaki, KH
Curb, JD
Blanchette, PL
机构
[1] Univ Hawaii, Geriatr Med Program, John A Hartford Ctr Excellence Geriatr Med, John A Burns Sch Med, Honolulu, HI 96817 USA
[2] Pacific Hlth Res Inst, Honolulu, HI USA
[3] Kuakini Med Ctr, Honolulu, HI USA
关键词
D O I
10.1001/archinte.160.19.2964
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Recognition and medical record documentation of dementia in the primary care setting are thought to be poor. To our knowledge, previous studies have not examined these issues in private practice office settings within the United States. Objective: To determine the rate of unrecognized and undocumented dementia in a primary care internal medicine private practice. Methods: This was a cross-sectional study of 297 ambulatory persons aged 65 years and older attending an internal medicine private group practice within an Asian American community of Honolulu, Hawaii. Of the subjects, 95% had been with their current primary care physician for at least 1 year. Each subject's primary care physician noted the presence or absence of dementia by questionnaire at the time of an office visit. An investigating physician (V.G.V.) subsequently assessed cognitive function using the Cognitive Abilities Screening Instrument, and confirmed the presence of dementia and its severity, if present, using Benson and Cummings' criteria and the Clinical Dementia Rating Scale, respectively. A trained research assistant completed telephone interviews to proxy informants for collateral information concerning cognition, behavior, and occupational or social function. Subjects' outpatient medical records were reviewed for documentation of problems with cognition. Results: Twenty-six cases of dementia were identified. Of these 26, 17 (65%) (95% confidence interval, 44.3-82.8) were not documented in outpatient medical records; of 18 patients, 12 (67%) (95% confidence interval, 40.9-86.7) were not thought to have dementia by their physicians at the time of the office visit. Recognition and documentation rates increased with advancing stage of disease. Conclusion: Dementia is often unrecognized and undocumented in private practice settings.
引用
收藏
页码:2964 / 2968
页数:5
相关论文
共 30 条
[1]   Height as a marker of childhood development and late-life cognitive function: The Honolulu-Asia Aging Study [J].
Abbott, RD ;
White, LR ;
Ross, GW ;
Petrovitch, H ;
Masaki, KH ;
Snowdon, DA ;
Curb, JD .
PEDIATRICS, 1998, 102 (03) :602-609
[2]  
BLESSED G, 1988, PSYCHOPHARMACOL BULL, V24, P705
[3]   Diagnosing dementia: Perspectives of primary care physicians [J].
Boise, L ;
Camicioli, R ;
Morgan, DL ;
Rose, JH ;
Congleton, L .
GERONTOLOGIST, 1999, 39 (04) :457-464
[4]   Perceptions of dementia, caregiving, and help seeking among Asian and Pacific Islander Americans [J].
Braun, KL ;
Browne, CV .
HEALTH & SOCIAL WORK, 1998, 23 (04) :262-274
[5]   DOCUMENTATION AND EVALUATION OF COGNITIVE IMPAIRMENT IN ELDERLY PRIMARY-CARE PATIENTS [J].
CALLAHAN, CM ;
HENDRIE, HC ;
TIERNEY, WM .
ANNALS OF INTERNAL MEDICINE, 1995, 122 (06) :422-429
[6]  
COSTA PTJ, 1996, AHCPR PUBLICATION
[7]  
Cummings J.L., 1992, Dementia: A clinical approach
[8]   THE US ECONOMIC AND SOCIAL COSTS OF ALZHEIMERS-DISEASE REVISITED [J].
ERNST, RL ;
HAY, JW .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1994, 84 (08) :1261-1264
[9]   MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[10]   PRIMARY-CARE PHYSICIANS DIAGNOSTIC, MANAGEMENT, AND REFERRAL PRACTICES FOR OLDER PERSONS AND FAMILIES AFFECTED BY DEMENTIA [J].
FORTINSKY, RH ;
LEIGHTON, A ;
WASSON, JH .
RESEARCH ON AGING, 1995, 17 (02) :124-148