Implementing a Screening and Diagnosis Program for Dementia in Primary Care

Authors

  • Malaz Boustani MD, MPH,

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
    3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind, USA
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  • Christopher M. Callahan MD,

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
    3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind, USA
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  • Frederick W. Unverzagt PhD,

    1. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Ind, USA.
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  • Mary G. Austrom PhD,

    1. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Ind, USA.
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  • Anthony J. Perkins MS,

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
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  • Bridget A. Fultz MA,

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
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  • Siu L. Hui PhD,

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
    3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind, USA
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  • Hugh C. Hendrie MB, ChB

    1. Indiana University Center for Aging Research, Indianapolis, Ind, USA
    2. Regenstrief Institute, Inc., Indianapolis, Ind, USA
    3. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Ind, USA.
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Address correspondence and requests for reprints to Dr. Boustani: Regenstrief Institute, Inc., 1050 Wishard Blvd., RG6, Indianapolis, IN 46202-2872 (e-mail: mboustani@regenstrief.org).

Abstract

Background: Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care.

Methods: We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records.

Results: Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment—no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record.

Conclusions: Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.

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