Tertiary center referral delay of patients with dementia in Southern Brazil: associated factors and potential solutions.

Brunna De Bem Jaeger,Márcia Lorena Fagundes Chaves,Raphael Machado Castilhos,Milena Lemos Oliveira

doi:10.1590/1980-57642021dn15-020008

Abstract

ABSTRACT.Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist.Objective: We aimed to study the average time from disease onset to specialist assessment and related factors; we also propose potential strategies to deal with this delay.Methods: This was a cross-sectional database study in 245 patients with dementia from an outpatient clinic in a tertiary university hospital in Southern Brazil, which only assesses individuals from the Unified Health System (SUS). The outcome was time from symptoms onset to specialist assessment, reported by the informants. Individuals were separated into two groups: less and more than 1 year to specialist assessment. Multivariable analysis was used to test the potential related factors associated with delayed specialist assessment.Results: Mean±SD of time from symptoms onset to specialist assessment was 3.3±3.3 years. In the unadjusted analysis, individuals who were assessed before 1 year were more often diagnosed with vascular dementia, had more sudden and subacute onset, neuropsychiatric symptoms at presentation, rapid progression, and alcohol and antipsychotics use (p<0.05). In multivariate analysis, the effects of personality changes and onset presentation persisted, even when controlling for other variables.Conclusion: We found a long time from disease onset to specialist assessment, and those with personality changes and faster presentation were referred earlier. Improving the diagnostic capability of general practitioners, mass educational campaigns and transmission of knowledge by experts are some potential strategies to deal with delay of dementia diagnosis.

Highlights

The population aging process is ongoing worldwide and poses major challenges to health care systems, especially in low-income regions, such as Latin America
The mean time from symptoms onset to specialist assessment was 3.3±3.3 years, and most patients were evaluated 1 year after disease onset (79.6%) (Table 1)
The following factors were significantly different between groups: alcohol use, onset presentation, symptoms at presentation, disease progression, and antipsychotic use (Table 1)

Summary

Introduction

The population aging process is ongoing worldwide and poses major challenges to health care systems, especially in low-income regions, such as Latin America. An increasing prevalence of dementia is a predictable consequence of this process.[1] Among several challenges in dementia care, both globally[2] and especially in Latin America,[3] timely diagnosis is essential. Diagnosis has many benefits, such as delaying of institutionalization, decreasing caregiver burden, and reducing the costs.[4,5] Individuals with dementia take a long time from symptoms onset to diagnosis. Delays in dementia diagnosis have been identified in several regions,[6,7,8] mostly in high-income countries. A recent systematic review found no study in low-income countries assessing the frequency of undetected dementia, estimating that it can reach 93%.9. In evaluating factors influencing delays in the diagnosis of Alzheimer’s disease, showed a median of 1.5 years until tertiary evaluation and diagnosis.[10]

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Conclusion