Abstract
Objective: The aim of this study was to describe patients assessed for cognitive decline in primary healthcare, compared to patients assessed in specialist healthcare and to examine factors associated with depression.Design: This was an observational study.Setting: Fourteen outpatient clinics and 33 general practitioners and municipality memory teams across Norway.Subjects: A total of 226 patients assessed in primary healthcare and 1595 patients assessed in specialist healthcare outpatient clinics.Main outcome measures: Cornell scale for depression in dementia (CSDD), Mini-Mental Status Examination (MMSE), Clock drawing test, Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Instrumental Activities of Daily Living, Personal Self-Maintenance Scale, Relatives’ stress scale (RSS), and Neuropsychiatric Inventory Questionnaire (NPI-Q)Results: Patients assessed in primary healthcare were older (mean age 81.3 vs 73.0 years), less educated, had poorer cognition (MMSE median 22 vs 25), more limitations in activities of daily living (ADL), more behavioural and psychological symptoms of dementia (BPSD), more depressive symptoms (CSDD median 7 vs 5), more often lived alone (60% vs 41%) and were more often diagnosed with dementia (86% vs 47%) compared to patients diagnosed in specialist healthcare. Depression was associated with female gender, older age, more severe decline in cognitive functioning (IQCODE, OR 1.65), higher caregiver burden (RSS, OR 1.10) and with being assessed in primary healthcare (OR 1.53).Conclusion: Post-diagnostic support tailored to patients diagnosed with dementia in primary healthcare should consider their poor cognitive function and limitations in ADL and that these people often live alone, have BPSD and depression.Key pointsPeople diagnosed in Norwegian primary healthcare had more needs than people diagnosed in specialist healthcare. • They were older, less educated, had poorer cognitive functioning and activity limitations, more often lived alone, and had more BPSD and depression. • Depression was associated with being female, older, having cognitive decline, being assessed in primary care and the caregiver experiencing burden • Post diagnostic support for people with dementia should be tailored to the individual’s symptoms and needs.
Highlights
The number of people with dementia was estimated to be 35.6 million in 2010, a number expected to double every 20 years [1]
Characteristics of the PrimCare cohort compared to the SpecCare memory clinics cohort There was a larger proportion of women in the PrimCare cohort than in the memory clinic cohort; PrimCare relatives were older and reported higher caregiver burden; and PrimCare patients had significantly more symptoms on all three Neuropsychiatric Inventory Questionnaire (NPI-Q) domains
We found that patients diagnosed in primary healthcare were older, less educated, had poorer cognition and more limitations in activities of daily living (ADL), had more behavioural and psychological symptoms of dementia (BPSD), more depressive symptoms, more often lived alone, and were diagnosed with dementia more often compared to patients diagnosed in specialist healthcare
Summary
The number of people with dementia was estimated to be 35.6 million in 2010, a number expected to double every 20 years [1]. Thorough assessment and diagnosis are keys to providing effective medical treatment and individually tailored support for people with dementia. Many with dementia are not assessed or given a timely diagnosis, M. Common unmet needs of people with dementia involve daytime activities, social companionship, and psychological needs [3]; facilitating participation in meaningful activities may improve well-being in this population [4]. Depression is common in people with dementia [5] and may lead to negative outcomes including reduced quality of life, disability in activities of daily living (ADL), and a more rapid development of cognitive decline [6]. Assessing people with cognitive decline for symptoms of depression and targeting support when symptoms are present are important
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