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Diagnosing dementia is difficult and expensive for primary care practices

Dementia afflicts from 3 to 11 percent of people aged 65 and over. Sixty percent of people with dementia have Alzheimer's disease. A study supported by the Agency for Healthcare Research and Quality (HS10884) found that diagnosing patients with dementia is difficult and expensive.

Researchers screened 3,340 elderly patients for dementia who had no cognitive symptoms during a routine visit to 1 of 7 Indianapolis urban primary care practices. Based on a positive score on a 6-item screening instrument and a score of 24 points or fewer on the Community Screening Interview for Dementia, 434 people were considered to have dementia and were eligible for diagnostic assessment.

Of the 227 people who agreed to a formal diagnostic assessment, 107 (47 percent) were diagnosed with dementia, 74 (33 percent) had cognitive impairment without dementia, and 46 (20 percent) were considered to have no cognitive deficit. After adjusting for patients who refused the diagnostic assessment, 6 percent of the overall primary care older population had dementia. However, physicians documented dementia in the medical records of only 19 percent of all patients identified with dementia by the diagnostic assessment.

The overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program. Thus, clinicians must rely on detailed diagnostic assessments before making a dementia diagnosis.

More details are in "Implementing a screening and diagnosis program for dementia in primary care," by Malaz Boustani, M.D., M.P.H., Christopher M. Callahan, M.D., Frederick W. Unverzagt, Ph.D., and others, in the July 2005 Journal of General Internal Medicine 20, pp. 572-577.

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