Encouraging patients with potential memory deficits to seek early advice from a general practitioner (GP) empowered more of them to consult their GP, but GPs did not change their behavior and refer more to memory services or for earlier overall diagnosis of dementia, according to a trial publishing this week in PLOS Medicine by Gill Livingston, of University College London, and colleagues.
Early diagnosis of dementia allows patients and families to plan for the future, receive symptomatic treatment, access social and voluntary care, and delays care home entry, with few negative effects. To determine whether reaching out directly to patients could lead to earlier diagnoses of dementia, Livingston and colleagues conducted a cluster-randomized controlled trial in 22 general practices in South-East England. Eligible patients from 11 practices assigned to the intervention (6387 patients who were >70 years old, living in their own homes and without known diagnosis of dementia) received a personally signed letter and information leaflets with information about overcoming common barriers to accessing dementia diagnosis and care, while patients in 11 control practices (8171 patients who met the same criteria) received usual care. Compared to control, the intervention had no significant effect on the primary outcome, earlier dementia diagnosis at memory clinics, as measured by the Mini Mental State Examination. There was a significant increase in the proportion of patients in the intervention practices consulting their GPs with suspected memory problems compared to control practices, but no difference in proportion of patients who were referred to memory specialist clinics by the GPs.
The authors note that it is unclear why additional patients presenting to GPs did not lead to earlier overall diagnosis of dementia, though they speculate that some patients may have been "worried well", or that early memory problems were not recognized by the GPs.
The authors suggest that to increase early diagnosis it may be necessary to inform both sides of the doctor-patient relationship: "Interventions likely to be successful in decreasing cognitive severity at diagnosis will need to target both the public and practitioners and particularly concentrate on the benefits of earlier diagnosis."
This article appears in the PLOS Medicine Special Issue on Dementia, publishing every week throughout March.
The study was funded by the Alzheimer's Society UK PG-2012-183. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors have declared that no competing interests exist.
Livingston G, Baio G, Sommerlad A, de Lusignan S, Poulimenos S, Morris S, et al. (2017) Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial. PLoS Med 14(3): e1002252. doi:10.1371/journal.pmed.1002252
Division of Psychiatry, University College London, London, United Kingdom Camden and Islington NHS Foundation Trust, London, United Kingdom Department of Statistical Science, University College London, London, United Kingdom Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom Department of Applied Health Research, University College London, London, United Kingdom Research Department of Primary Care and Population Sciences, University College London, London, United Kingdom
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