Study Examines Barriers to Dementia Diagnosis
Dementia is a growing public health concern, with a recent study finding that 13.9% of Americans older than age 70 have some form of dementia, most commonly due to Alzheimer's disease. Currently, the diagnosis of dementia is initiated mostly on a clinician's suspicion that is based on patient symptoms or caregiver concerns, usually in a primary care setting. However, diagnosing dementia in a primary care setting may be difficult due to the brevity of the patient/provider interaction, and because many older patients present with multiple health conditions needing attention. The goals of this study were to ascertain what is known about the prevalence of missed and delayed diagnosis of dementia in primary care, and to identify factors contributing to problems in diagnosis. Investigators conducted a systematic review of the literature through June 2008 and found 40 studies relevant to their goals.
While the findings did not definitively determine the prevalence of missed or delayed dementia diagnoses, estimates suggest that the number is substantial. Major barriers to diagnosing dementia included patient/provider communication (e.g., poor provider communication skills, language barriers), education deficits (e.g., belief that little or nothing can be done to treat dementia), and system resource constraints (e.g., time constraints for office visits). Attitude problems also were found; for example, among providers, a major barrier often noted was the attitude that diagnosis, particularly in the early stages of dementia, was more harmful than helpful, while patients often feared and/or denied cognitive problems. The authors suggest that until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.
Bradford A, Kunik M, Schulz P, Williams S, and Singh H. Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors. Alzheimer Disease & Associated Disorders Oct-Dec 2009;23(4):306-314.
This study was partly funded by HSR&D. Ms. Bradford and Drs. Kunik and Singh are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.