Year: 1990
Type: article
Study design: Observational Study
Abstract: This paper is concerned with the awareness of general practitioners of dementing patients in their charge.The names of all 3,889 patients aged 75 years and over were taken from the age-sex registers of six group practices in Cambridge.Patients were asked through their doctors to take part in a screening interview which included the Mini-mental State Examination (MMSE), and 2,616 agreed.Those scoring below 24 (out of 30) and a one-in-three sample of those scoring 24-25 were assessed by a psychiatrist using a standardised interview schedule (CAMDEX).Dementia was diagnosed according to strict criteria.Independently of these assessments, doctors and community nurses were asked to identify patients from their lists whom they considered definitely, possibly or definitely not demented.Patients with an operational diagnosis of minimal dementia and those in long-stay hospital facilities were excluded.Of the 657 patients identified for further study on the basis of the MMSE, 532 (81%) were assessed by the research psychiatrist.After various exclusions, data on 444 patients were available for analysis, 208 of whom satisfied the CAMDEX criteria for dementia.General practitioners identified as possibly or definitely demented half of the patients with mild dementia, 61 % of those with moderate dementia and 78 % of those with severe dementia.Not surprisingly, they more commonly recognised dementia in the patients they had seen most often in the preceding year.Community nurses correctly identified two-thirds of their mildly demented and virtually all of their moderately and severely demented patients.Whereas general practitioners rated only 2 3 % of patients without CAMDEX dementia as possibly (17%) or definitely (5 %) demented, the nurses had a higher false-positive rate (46% overall, 32% possibly and 14% definitely).The authors comment that their methodology probably results in an underestimate of doctors' and nurses' diagnostic accuracy.
Source: Ageing and Society
Author: John Wattis
Institution: St James's University Hospital
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2121183151