Predicting dementia from primary care records: A systematic review and meta-analysis.

Elizabeth Ford,Stephen Bremner,Seb Oliver,Philip Rooney,Jackie Cassell,Sube Banerjee,Shanu Sadhwani,Nicholas Greenslade,Priya Paudyal,Helen E Smith

doi:10.1371/journal.pone.0194735

Elizabeth Ford, Stephen Bremner + Show 8 more

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https://doi.org/10.1371/journal.pone.0194735

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Abstract

IntroductionPossible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care.Methods and findingsWe conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies.From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer’s (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results.ConclusionsThese findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should also be explored in future studies.

Highlights

OPEN ACCESSCitation: Ford E, Greenslade N, Paudyal P, Bremner S, Smith HE, Banerjee S, et al (2018) Predicting dementia from primary care records: A systematic review and meta-analysis
These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care
Predictors of dementia in primary care fees from Eleusis, personal fees from Daval International, personal fees from BoehringerIngelheim, personal fees from Axovant, personal fees from Lundbeck, personal fees from Nutricia, outside the submitted work; he has been employed by the Department of Health for England

Summary

Introduction

Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. The World Alzheimer’s Report 2011 highlights the benefits of early diagnosis in allowing people with dementia and their families to make plans for the future, before their disease becomes too advanced.[3] Additional benefits include timely access to information, advice and support, and the person with dementia being able to express their wishes in a way which helps them to maximise their quality of life. Likewise current symptomatic treatments and future diseasemodifying medications are likely to have most effect if prescribed early in the illness.[3] Earlier diagnosis is likely to delay entry to care homes, reducing the costs to society of institutional care [4] and possibly contributing to quality of life, given that most elderly people express a preference to stay in their own home as long as is practicable. At the current time, diagnosis often happens at a late stage in the illness, or following a crisis (e.g. after hospitalisation due to a fall) when opportunities for maximising quality of life have passed.[3, 5] Higher diagnosis rates, and diagnosis earlier in the course of the disease, are strategic aims for the UK government and National Health Service (NHS), as described in the National Dementia Strategy,[6] Prime Minister’s Dementia Challenge,[7] NHS England Dementia Identification Scheme,[8] and the GP Dementia Toolkit.[9]

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