A trial of early recognition and management of dementia in general practice

To investigate the feasibility of early assessment of preventable disabilit ies in primary care, we developed a geriatric preventive screening examinat ion with various indicators of physical, emotional, and social functions as well as laboratory exams. Cognitive impairment was measured by the modifie d MMSE. Severe cases of dementia, who would deserve home visits were exclud ed. Results of the assessment procedure in 446 patients aged 70 and over (7 1.5 % females) were compared to ratings of,of general practioners (n = 67). In these patients we found 4250 medical, 374 psychiatric, and 528 social p roblems. 45.4 % of medical, 61.8 % of psychiatric, and 56.8 % of social pro blems where hitherto unkown to the GPs. The prevalence of cognitive impairm ent was 4.6 % according to Ops diagnosis and 21 % according to the MMSE. Th e sensitivity of Ops diagnosis was 14 %, the specifity 98 %, and the overal l agreement measured by kappa was 0.17. There were significant (p < 0.05) a ssociations of cognitive impairment with poor health, vascular disease, syn cope, weight loss, previous: hospitalization, depression, and ADL and IADL- items. Hypertension, or pathological thyroid function, occurred more freque ntly in the cognitively impaired (p > 0.05). Only 19.5 % of dementia cases had severe functional loss, which substantiates our hypothesis that mild de mentia was studied. Of all cases with newly identified cognitive impairment (n = 83 of 446 patients), three (3.6 %) had reversible. disorder such as d epression (n = 1), drug toxicity (n = 2) 3 (3.6 %) received counseling, and 5 (6 %) further diagnostic assesssment or treatment. One (1.2 %) patient d id not accept, any treatment. In the remainder of 71 patients (85.5 %), the Ops adopted a wait and see strategy with no intervention. In conclusion, m emory deficits seem to be underdiagnosed in general practice despite much t reatable comorbidity or social problems, and some reversible conditions suc h as depression and drug adverse effects.