Time from symptom onset to specialist consultation and associated factors in the assessment of dementia in a dementia clinic in Southern Brazil

Abstract

AbstractBackgroundIn the Brazilian unified health system (SUS) most dementia cases are referred by the general practitioner to the specialist for diagnosis, which may increase complexity of the process and can cause delay for diagnosis.MethodA cross‐sectional database study with 245 dementia patients from an outpatient clinic in a tertiary university hospital in Southern Brazil was carried out to evaluate time from onset of symptoms to specialist consultation and associated factors in the assessment of dementia. The outcome variable was time from symptom onset to specialist assessment, reported by informants in the first consultation. For the analysis, participants were classified into two groups according to time for diagnostic evaluation (≤ and > 1 year; 20% x 80%). An univariate analysis was used to test the potential related factors associated with the delayed specialist assessment, and a multivariate logistic regression model was used to test association with the outcome.ResultThe mean time to theh specialist assessment was 3.3 ± 3.3 years. In the unadjusted analysis, individuals who were assessed after 1 year were diagnosed with Alzheimer’s isease, while who came before 1 year were most likely diagnosed with vascular dementia and other dementia types, had more sudden and subacute onset, neuropsychiatric symptoms at presentation, rapid progression, alcohol and antipsychotics use (p < 0.05). In the multivariate analysis, the effects of personality changes and onset presentation persisted, even controlling for other significant characteristics. The mean time to the specialist assessment was 3.3 ± 3.3 years. In the unadjusted analysis, individuals who were assessed after 1 year were mostly diagnosed with Alzheimer’s disease, while those who came before 1 year were most likely diagnosed with vascular dementia and other dementia types, had more sudden and subacute onset, more personality changes at presentation, rapid progression, and alcohol and antipsychotics use (p < 0.05). In the multivariate logistic regression, personality changes and onset presentation kept the association with time for assessment.ConclusionWe found a long time from symptoms onset to specialist assessment in the public system. Individuals with more disrupting presentations such as personality changes and a faster presentation were referred earlier.