Researchers found the most frequently cited barriers to diagnosis of dementia in this study are the differing priorities of patients and doctors. GPs must depend on either the patient or a relative to alert them to symptoms of dementia. GPs alluded to challenges with proper timing of referral to support services. GPs also reported that they feared damaging the doctor-patient relationship, especially around the issue of declaring the patient unable to drive safely.
"Older patients frequently have complex and overlapping illnesses involving multiple body systems. Often these diseases are having a bigger impact on their day to day lives than mild cognitive impairment," Paterson said. "As a result, when they see the doctor, their priority is to have their non-cognitive health needs addressed."
If a patient appeared to be functioning well, GPs in this study were less likely to suspect cognitive impairment. GPs reported that a cognitive deficit is more often brought to their attention by a relative or caregiver than by the patient. Such an informant is seen as vital for early diagnosis.
GPs reported they find it hard to remember to re-offer referral to support services. GPs suggest these services to patients soon after the diagnosis. However, patients and caregivers are adjusting to the diagnosis at this time and may be suffering from denial, anger and guilt, and will often reject the referral. When they are ready to accept support, the GP may be unaware that their attitudes have changed.
The researchers recommend doctors be educated to have a higher level of suspicion for symptoms of cognitive decline, especially in caregivers and in people with complex, multi-system diseases. They suggest that GPs offer referrals to support services for people with dementia and caregivers on multiple occasions during the diagnostic and treatment process. A literature review conducted by the same researchers reinforced these themes and suggested that the involvement of practice and community nurses in the diagnostic process may overcome some of the barriers and improve detection rates.
SOURCE: Research reported at the 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna, Austria, July 12, 2009
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