Diagnosis of later life cognitive impairment in primary care: demographics, diagnoses and severity in TIMeLI towards improving diagnosis of memory loss in general practice.

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.16

Presenter:

Sam Creavin

Co-authors:

Creavin ST, Cullum SJ, Haworth J, Wye L, Bayer A, Fish M, Purdy S, Ben-Shlomo Y

Author institutions:

University of Bristol, University of Cardiff, University of Auckland

Problem

People with cognitive problems have traditionally been evaluated exclusively in a specialist memory clinic but policy makers and research priority setting groups have asked how primary care can support a more effective diagnostic pathway.

Approach

We prospectively recruited adults aged at least 70 years who attended one of 20 participating GP surgeries in Avon with cognitive symptoms for at least six months and who did not have an existing diagnosis of dementia, . We investigated the accuracy of 17 common index tests including the GPs clinical judgement for the diagnosis of dementia syndrome using the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV definition against the reference test 1hour standardised specialist clinical evaluation, blinded to index tests. The specialist performed a standardised clinical assessment including the Addenbrooke’s Cognitive Examination third edition (ACE3) and assessment of mood and activities of daily living, but intentionally blinded to investigation results. A consensus review panel of three experts to review investigations and follow-up data is underway.

Findings

We recruited 114 women and 127 men; 132 had dementia (ACE3 | age in years median;IQR. ACE3 69; 61 to 74 | 82years; 72years to 87years), 63 had mild cognitive impairment (MCI) (ACE3 83; 76 to 87 | 79years; 75years to 83years ), 41 were normal (ACE3 94; 91 to 96 | 75years; 72years to 87years), and 5 could not be classified by the single specialist on the basis of the information at the cross sectional assessment (ACE 80; IQR 72 to 87 | 85years; 84years to 86years). Montreal Cognitive Assesement (MoCA) was the most sensitive single test (sensitivity 100%; 95% CI: 97% to 100%, specificity 17%; 95% CI: 10% to 26%). Lawton assesement of activities of daily living was the most specific single test (specificity 97%; 95% CI: 92% to 99%, sensitivity 16%; 95% CI: 10% to 23%). GPs clinical judgement was the only single test with a specificity of more than 85% (90%; 95% CI: 82% to 95%) and sensitivity of at least 50% (57%; 95% CI 48% to 66%). Analysis continues, further results will be available.

Consequences

Our results facilitate evaluation of people with cognitive problems in primary care.

Submitted by:

Sam Creavin

Funding acknowledgement:

Wellcome Trust