Diagnosis Of Dementia In Primary Care Research Articles

MINDER Smart home test bed site – embedding dementia research into primary health and social care. Wingfield, D. Daniels, S. Norman, C. Lai, H. Hassim, N. Nilforooshan, R. Barnarghi, P. Sharp, D

AbstractBackgroundDigitally enabled healthcare is becoming mainstream NHS (1) and adoption has been accelerated in response to the COVID‐19 pandemic (2) The UK Dementia Research Institute Care Research & Technology Centre, established in 2019, explores the value of using technology in people’s homes to improve care and has developed a system (MINDER) using IOT/smart home technology and medical devices, integrating activity and health data for research purposes and generating health alerts to the mainstream provider via a clinical monitoring team. Initially launched in Surrey and Borders Partnership NHS Trust (n = 40); in April 2021, an additional research site was established within primary care in North West London.MethodWe collated data from both sites and describe an integrated delivery model for research within primary health and social care. Cohort description and case studies illustrate the challenges and benefits of conducting this research across urban and sub‐urban settings.ResultsOver 55 participants are currently enrolled on the study. 15 of these from primary care/general practice in the London Borough of Hammersmith and Fulham. Opportunities arising from this setting include leveraging the patient – provider (nurse/doctor/allied health professional/social care) relationship to introduce the study and recruit, and rapid escalation of any problems arising in a research context to the clinical/care teams responsible to delivering care (for example; potential urinary tract infections). Challenges to recruitment have included lack of specialist confirmation of dementia diagnosis in primary care records, lack of consistent engagement/availability of the required MINDER study partner as well as the impact of the COVID 19 pandemic limited face to face contact.ConclusionEarly data suggests that a complex dementia study can be embedded successfully in General Practice and leads to strengthening of relations with care giving bodies. This offers the opportunity for development and translation of new technologies within front line primary and social care, that can be fully evaluated within the real world context of service delivery.References 1)The NHS Long Term Plan (2019) gov.uk 2) Baird B, Maguire D. Understanding factors that enabled digital service change in general practice during the Covid‐19 pandemic. London: The King’s Fund. 2021 Feb.

What gets recorded, counts: dementia recording in primary care compared with a specialist database.

Backgrounddatabases of electronic health records are powerful tools for dementia research, but data can be influenced by incomplete recording. We examined whether people with dementia recorded in a specialist database (from a mental health and dementia care service) differ from those recorded in primary care.Methodsa retrospective cohort study of the population covered by Lambeth DataNet (primary care electronic records) between 2007 and 2019. Documentation of dementia diagnosis in primary care coded data and linked records in a specialist database (Clinical Records Interactive Search) were compared.Results3,859 people had dementia documented in primary care codes and 4,266 in the specialist database, with 2,886/5,239 (55%) documented in both sources. Overall, 55% were labelled as having Alzheimer’s dementia and 29% were prescribed dementia medication, but these proportions were significantly higher in those documented in both sources. The cohort identified from the specialist database were less likely to live in a care home (prevalence ratio 0.73, 95% confidence interval 0.63–0.85), have multimorbidity (0.87, 0.77–0.98) or consult frequently (0.91, 0.88–0.95) than those identified through primary care codes, although mortality did not differ (0.98, 0.91–1.06).Discussionthere is under-recording of dementia diagnoses in both primary care and specialist databases. This has implications for clinical care and for generalizability of research. Our results suggest that using a mental health database may under-represent those patients who have more frailty, reflecting differential referral to mental health services, and demonstrating how the patient pathways are an important consideration when undertaking database studies.

Machine-learning based identification of undiagnosed dementia in primary care: a feasibility study.

BackgroundUp to half of patients with dementia may not receive a formal diagnosis, limiting access to appropriate services. It is hypothesised that it may be possible to identify undiagnosed dementia from a profile of symptoms recorded in routine clinical practice.AimThe aim of this study is to develop a machine learning-based model that could be used in general practice to detect dementia from routinely collected NHS data. The model would be a useful tool for identifying people who may be living with dementia but have not been formally diagnosed.Design & settingThe study involved a case-control design and analysis of primary care data routinely collected over a 2-year period. Dementia diagnosed during the study period was compared to no diagnosis of dementia during the same period using pseudonymised routinely collected primary care clinical data.MethodRoutinely collected Read-encoded data were obtained from 18 consenting GP surgeries across Devon, for 26 483 patients aged >65 years. The authors determined Read codes assigned to patients that may contribute to dementia risk. These codes were used as features to train a machine-learning classification model to identify patients that may have underlying dementia.ResultsThe model obtained sensitivity and specificity values of 84.47% and 86.67%, respectively.ConclusionThe results show that routinely collected primary care data may be used to identify undiagnosed dementia. The methodology is promising and, if successfully developed and deployed, may help to increase dementia diagnosis in primary care.

Three simple questions have high utility for diagnosing dementia in the primary care setting

ABSTRACT FROM: Creavin S, Fish M, Gallacher J, et al . Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study. Br J Gen Pract 2015;65:e489–99. Dementia prevalence is...

Dementia diagnosis in primary care: A qualitative study of gp attitudes and practices in the east of england

Dementia diagnosis in primary care: A qualitative study of gp attitudes and practices in the east of england

Dementia Diagnosis in Primary Care: Thinking Outside the Educational Box

Dementia syndromes are common, increasing in prevalence and are the largest cause of disability in industrialized societies. The costs of care for people with dementia in the UK are greater than the annual expenditure on heart disease, stroke and cancer, combined. Delayed recognition of dementia is common in community settings, but its causes are poorly understood. Specialists tend to identify lack of diagnostic skills amongst primary care physicians as the main cause, and attempt to remedy these limitations with training and the use of brief instruments for assessing cognition. This approach appears to have had little impact over the last decade. There are fundamental misunderstandings regarding how the diagnostic characteristics of dementia syndromes diverge from the cognitive changes of normal aging, and how dementia emerges through the personality of the individual. This paper discusses the factors/processes involved in these changes in cognitive function, behavior and personality and why recognition of dementia in primary care is problematic, especially at an early stage. The important and tractable factors impeding earlier recognition of dementia in primary care include deficits in management (rather than diagnostic) skills amongst primary care practitioners and lack of adequate specialist support (including psychology and social work expertise) over the long term. Nevertheless, we believe that the diagnosis and early clinical management of dementia can be achieved in the setting of primary care. The pattern of interweaving psychological, social and economic factors relevant to the needs of individual patients and their carers can be taken into account and met in the community, providing sufficient expert resources are available and systematically organized. This paper explores the different dimensions of relevant management skills and systems and makes proposals regarding changes in primary and secondary care that will increase earlier diagnosis in the community.

Dementia diagnosis in primary care: Results of a representative survey in Southern Lower Saxony, Germany : J. Staedt, G. Stoppe, H. Sandholzer ∗, S. Winter, J. Kiefer, M. Kochen ∗, E. Rüther. Depts. of Psychiatry and General Practice ∗, University of Goettingen, 37075 Goettingen, Germany

Dementia diagnosis in primary care: Results of a representative survey in Southern Lower Saxony, Germany : J. Staedt, G. Stoppe, H. Sandholzer ∗, S. Winter, J. Kiefer, M. Kochen ∗, E. Rüther. Depts. of Psychiatry and General Practice ∗, University of Goettingen, 37075 Goettingen, Germany