Abstract
BackgroundTo understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care.MethodsDatabases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework.ResultsTwenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers.ConclusionsThere are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.
Highlights
To understand how best to approach dementia care within primary care and its challenges, we exam‐ ined the evidence related to diagnosing and managing dementia within primary care
65 % of dementia cases are undiagnosed in primary care, which negatively impacts these patients by not implementing advanced care planning and management strategies before the dementia progresses [3]
The Abbreviated Mental Test Score (AMTS) is suitable for detecting dementia within primary care given its high sensitivity and short administration time
Summary
To understand how best to approach dementia care within primary care and its challenges, we exam‐ ined the evidence related to diagnosing and managing dementia within primary care. The impact of dementia is far reaching, as it affects the person with dementia, and their family carers, the healthcare system and society as a whole [1]. There is an underuse of diagnostic assessment tools and a lack of attention to the issues faced by family caregivers [2]. 65 % of dementia cases are undiagnosed in primary care, which negatively impacts these patients by not implementing advanced care planning and management strategies before the dementia progresses [3]. The U.S Preventative Services Task Force recommends that clinicians assess cognitive functioning when a patient is suspected of cognitive impairment based on the physician’s observation or caregiver concerns [3]. It is not clear that these are the best screening tools for use in primary care
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