Article

Practical Guidelines for the Recognition and Diagnosis of Dementia

Center of Excellence for Brain Aging, New York University Langone School of Medicine, New York, NY 10016, USA.
The Journal of the American Board of Family Medicine (Impact Factor: 1.85). 05/2012; 25(3):367-82. DOI: 10.3122/jabfm.2012.03.100181
Source: PubMed

ABSTRACT To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver status.

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    • "Recently, research interest has developed in detecting dementia in the primary health care setting. Though it has been estimated that around 39% of individuals afflicted with dementia seek care at specialty clinics (Galvin & Sadowsky, 2012), this percentage generally represents individuals with more advanced dementia. Most persons with mild to moderate dementia initially present to primary care physicians, often for seemingly unrelated problems , are often missed and remain undiagnosed. "
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    • "National and international dementia guidelines recommend straightforward diagnosis of dementia and provision of information about, among other things, the course, prognosis, treatment options, services, and legal and financial issues (Patterson et al., 1999; National Collaborating Centre for Mental Health (UK), 2007; Albert Weale et al., 2009; Segal-Gidan et al., 2011; Galvin and Sadowsky, 2012; Sorbi et al., 2012). This should be done in a manner consistent with the patient's Correspondence should be addressed to: Pim van den Dungen, Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. "
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    ABSTRACT: Background: Studies in memory clinics suggest that the majority of patients would like to know of a diagnosis of dementia. It is less clear what preferences are in the community. Our objective was to review the literature on preferences regarding disclosure of a diagnosis of dementia and to assess key arguments in favor of and against disclosure. Methods: Systematic search of empirical studies was performed in Pubmed, Embase, and Psycinfo. We extracted preferences of individuals without cognitive impairment (general population; relatives of dementia patients; and physicians) and preferences of individuals referred to a memory clinic or already diagnosed with dementia. A meta-analysis was done using a random effects model. Our main conclusions are based on studies with a response rate ≥75%. Results: We included 23 articles (9.065 respondents). In studies with individuals without cognitive impairment, the pooled percentage in favor of disclosure was 90.7% (95%CI: 83.8%-97.5%). In studies with patients who were referred to a memory clinic or already diagnosed with dementia, the pooled percentage that considered disclosure favorable was 84.8% (95%CI: 75.6%-94.0%). The central arguments in favor of disclosure pertained to autonomy and the possibility to plan one's future. Arguments against disclosure were fear of getting upset and that knowing has no use. Conclusions: The vast majority of individuals without and with cognitive impairment prefers to be informed about a diagnosis of dementia for reasons pertaining to autonomy.
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