Background

Dementia is widely acknowledged to be under-diagnosed. In an effort to improve diagnosis rates, routine screening of the at risk population by GPs has been proposed.

In the past, routine check-up visits by nurses to patients over the age of 75 may have been expected to pick up on signs of dementia even though there was no explicit screening for the condition included in the visit.

In this context, it is worth analysing the mode of presentation of the illness and, in particular, whether any changes in this between the earlier period referred to above and the present offers any indication of the likely efficacy of the proposed screening by GPs.

(Changing) Modes of Presentation of Dementia at an Aberdeen City PracticeDr Catriona West, Carden Medical Centre, Aberdeen 2013

Results and Discussion

Key Aims

• Identification of the key modes of presentation for patients presenting with symptoms leading to a diagnosis of dementia.

• Identification of any changes over time in mode of presentation.

• Identification of the apparent significance of presentation linked to a routine nurse check up visit.

Methods

•Vision was searched to identify patients diagnosed with dementia via Carden Medical Centre, Aberdeen in the years 2006, 2007 and 2012 (The data for 2006 and 2007 were combined to produce a single earlier time period falling within the period during which the routine nurse visits took place.)

•Patient notes were then reviewed to identify modes of presentation for these patients (self, spouse, family etc). Patient MMSE scores at time of presentation were also noted in case this data generated any results useful in interpreting the primary findings.

•The data for the two time periods were compared and conclusions drawn.

Conclusions

•Reporting by family, reporting by spouse, and in-patient admission, have been the most significant modes of presentation for patients presenting with symptoms which lead to a diagnosis of dementia for this Aberdeen City practice. The data offers no evidence that earlier approximations to routine screening aided in the diagnosis of dementia.

•At this practice, a shift has occurred over recent years from family reporting to spouse reporting as the most significant mode of presentation. MMSE scores at the time of diagnosis have also risen over the same period.

Self

Spouse

Family GP

Friend/n

eighbour

In-patient

Psychiatry

OP other

Not known

0123456789

Differences in Mode of Presentation for Patients Presenting with Symptoms Leading to a Diagnosis of Dementia in an Aberdeen City Practice in 2012 vis-a-vis 2006/07

Year 2006/7

Year 2012

6%

29%

18%9%

9%

18%

6%

6%

Mode of Presentation for Patients Presenting with Symptoms Leading to a Diagnosis of Dementia in an Aberdeen City Practice

(Combined Data for 2006/07 and 2012)

Self

Spouse

Family

GP

Friend/neighbour

In-patient

Psychiatry

OP other

Year 2006/7 Year 20120

5

10

15

20

25

30

Difference in Average MMSE Score at Time of Dia-gnosis for Patients Diagnosed with Dementia via an

Aberdeen City Practice in 2012 vis-a-vis 2006/07

Whilst the scale of the study renders its results non-significant and its conclusions tentative, interesting observations can be made which might be worth exploring in a larger study.

•For the combined data (collapsed over the two time periods) spouse reporting, family reporting, and in-patient admission were the key modes of presentation. The data therefore offers no explicit indication that routine nurse visits played a significant role in diagnosis of dementia. It must be borne in mind, however, that suggestions made by a visiting nurse might have led to an apparently unrelated presentation in one of the other modes.

• In 2006/07, family reporting was the main mode of presentation and accounted for many more presentations than in 2012. Meanwhile, in 2012, spouse reporting was the main mode of presentation and accounted for many more presentations than in 2006/07. It accords with expectation that spouses may be best placed to observe the onset of dementia, and it seems possible that some change has occurred over the period under study which has translated this expectation for observation into actual reporting. Might this change be the result of increased awareness regarding dementia amongst the elderly age group, for instance?

•Patients referred for diagnosis in 2012 were found to have a higher MMSE score at time of diagnosis than those referred in 2006/07, suggesting the possibility of earlier referral or presentation. This observation may be due to increased public awareness of the condition or of medical awareness of the benefit of a timely diagnosis to gain benefit from new treatments.