Year: 2011
Type: article
Study design: Observational Study
Abstract: Dementia is a chronic, progressive and eventually fatal disorder characterized by cognitive decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function. Presently, dementia is under recognized in the primary care of older adults. Screening for dementia in primary care increases recognition and treatment of reversible causes of memory loss and may delay of disease progression. In addition, earlier identification of dementia through screening may improve the diagnostic process and provide opportunities for physicians to discuss prognosis, learn about patient's goals, and tailor prevention and disease management targets and may improve patient and family outcomes such as knowledge about dementia, preparedness for future medical decisions, and confidence in medical decision-making. Once patients screen positive, they may delay or decline a diagnostic assessment for dementia due to concerns about having others know about their cognitive status, the belief that dementia cannot be treated or a general negative attitude toward medical assessment. In addition, previous studies have found that despite a caregiver recognizing more benefits from diagnostic assessment, 70.3% had a hard time accepting their family member's cognitive decline and 67.7% were concerned with how the diagnosis would impact their own life. In an effort to design patient-centered interventions to increase screening and diagnostic assessments, it is important to understand and enumerate the behaviors regarding diagnostic assessment. The purpose of this cross-sectional survey study is to determine the characteristics and perceptions of patients who completed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) Questionnaire and screened positive for dementia but subsequently refused further diagnostic assessment for dementia compared to those who screened positive and agreed to a diagnostic assessment. Cross- sectional survey of 554 primary care patients 65 years old and older without a diagnosis of dementia attending urban primary care clinics in Indianapolis, Indiana, in 2008-2009. Perceptions of dementia screening were measured with the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) instrument. The PRISM-PC includes scales for benefits, stigma, independence, and suffering which are scored from 0 (strongly disagree on all items) to 100 (strongly agree on all items) with 50 as a neutral score. Refusing diagnostic assessment for dementia was determined by the percentage of patients who screened positive on at least one of two written screening instruments MMSE or CSI-D) but subsequently refused a diagnostic assessment at a specialty clinic. Associations were assessed between scores on the PRISM-PC questionnaire, screening performance, and behavior regarding diagnostic assessment for those with a positive screen. 497 individuals completed the PRISM-PC and agreed to dementia screening. Of those who agreed to screening, 63 (12.6%) screened positive. Among the 63 participants who screened positive, 21 (33.3%) accepted diagnostic assessment and 42 (66.6%) refused diagnostic assessment. Those who accepted diagnostic assessment did not differ in age, race, sex, education or income compared to those who refused diagnostic assessment. Individuals who refused diagnostic assessment following a positive screening test were more likely to live alone (p = 0.008). A bivariate comparison of the mean PRISM-PC scores of participants who accepted a diagnostic assessment and participants who refused it (Table 1) showed that there was a significant difference in the domain score for stigma of dementia screening (35.2 vs. 42.0; P = .045) but not in the domain scores for the benefits of dementia screening, the negative impact of dementia screening on independence, and the suffering related to dementia screening. There were also significant differences regarding the individual item that asked about agreement to be tested for Alzheimer's disease with a short questionnaire (3.9 vs. 3.5; P=023). In order to improve acceptance of diagnostic assessments for dementia, development of a decision aid that describes the components of what a diagnostic assessment entails as well as emphasizing potential benefits of early identification and acknowledgment of the perceived stigmata of having a dementia diagnosis may reduce patient reluctance to undergo a diagnostics assessment for dementia.
Source: Alzheimer s & Dementia
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2167062798