Practice Patterns in the Evaluation and Management of Dementia by Primary Care Residents, Primary Care Physicians, And Geriatricians (Clinical Report)

Practice Patterns in the Evaluation and Management of Dementia by Primary Care Residents, Primary Care Physicians, And Geriatricians (Clinical Report)

Dementia is a syndrome of acquired persistent dysfunction in several domains of intellectual functioning, including memory, language, visuospatial ability, and cognition. Approximately 10% of adults above age 65 and 50% of adults above age 90 have dementia (1). The annual health care–related costs and lost wages for US patients with dementia and their family caregivers is approximately $100 billion (2–5). While the majority of dementing illnesses are progressive, 11% of patients with cognitive decline have reversible causes, and the course of the disease may be modified by early diagnosis and therapeutic interventions (1). Given these factors as well as the social and psychosocial cost of dementing illnesses on patients and their families, early diagnosis and intervention are paramount. The number of persons with dementia increases as the population ages. The number of persons aged 65 and older in 2030 is projected to be twice as large as in 2000, growing from 35 million to 72 million and representing nearly 20% of the total US population (6). Given that the number of geriatricians is not increasing at a similar rate, family medicine and internal medicine physicians will be uniquely poised to be the first to identify cognitive changes indicative of dementia. Unfortunately, studies indicate that primary care physicians (PCPs) may not be identifying dementia in the majority of symptomatic patients. In 1995 Callahan et al found that PCPs recorded a diagnosis of dementia in only 23.5% of patients with demonstrated moderate to severe cognitive impairment (7). Further, those PCPs who reported difficulty establishing a diagnosis of dementia had difficulty communicating the diagnosis to patients and family members (7, 8). These findings were echoed by Valcour et al, whose cross-sectional study of primary care (internal medicine) patients aged 65 and older found that 91% of cases of mild dementia were overlooked, and 65% of dementia cases were not documented in the outpatient medical record (9).

Practice Patterns in the Evaluation and Management of Dementia by Primary Care Residents, Primary Care Physicians, And Geriatricians (Clinical Report)



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