Alzheimer Disease & Associated Disorders. 23(4):306-314, OCTOBER-DECEMBER 2009
DOI: 10.1097/WAD.0b013e3181a6bebc
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PMID: 19568149
Issn Print: 0893-0341
Publication Date: October-December 2009
Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors
Andrea Bradford;Mark Kunik;Paul Schulz;Susan Williams;Hardeep Singh;
+ Author Information
*Menninger Department of Psychiatry and Behavioral Sciences†Health Services Delivery and Organization Program, Houston VA HSR&D Center of Excellence at the Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine‡Department of Neurology§Section of Geriatrics, Department of Medicine∥Health Policy and Quality Program, Houston VA HSR&D Center of Excellence, and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, both at the Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
Abstract
Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.
