IngentaConnect The primary care diagnosis of dementia in Europe: An analysis usi...

Authors: De Lepeleire, J.¹; Wind, A. W.; Iliffe, S.²; Moniz-Cook, E. D.³; Wilcock, J.²; Gonzalez, V. M.⁴; Derksen, E.⁵; Gianelli, M. V.⁶; Vernooij-Dassen, M.⁵

Source: Aging and Mental Health, Volume 12, Number 5, September 2008 , pp. 568-576(9)

Publisher: Routledge, part of the Taylor & Francis Group

Abstract:

Objectives: To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. Method: A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries. Results: The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration. Conclusions: This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.

Keywords: dementia; diagnosis; family medicine; European guidelines; primary care

Document Type: Research article

DOI: 10.1080/13607860802343043

Affiliations: 1: Academisch Centrum Huisartsgeneeskunde, Katholieke Universiteit Leuven, Belgium 2: Centre for Ageing Population Studies, Department of Primary Care and Population Sciences, University College London, UK 3: Institute of Rehabilitation, University of Hull, UK 4: Sanidad Castilla y Leon (Sacyl), Primary Health Care Team of Villoria, Salamanca, Spain 5: Alzheimer Centre/Centre for Quality of Care Research, University Medical Centre St Radboud, Nijmegen, The Netherlands 6: Facolta di Medicina e Chirurgia, University of Genova, Italy

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The primary care diagnosis of dementia in Europe: An analysis using multidisciplinary, multinational expert groups