Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews

BMC Family Practice

Zahra Goodarzi¹  Jayna Holroyd-Leduc¹  Brooklynn Fernandes² 

[1] Departments of Medicine and Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, North Tower (Rm 930), 1403 29 St NW, T2N 2T9, Calgary, AB, Canada;Faculty of Science, University of Calgary, Calgary, Canada;

关键词: Dementia;    Primary care;    Family physician;    Systematic review;    Diagnosis;   

DOI  :  10.1186/s12875-021-01461-5

来源: Springer

【 摘 要 】

BackgroundTo understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care.MethodsDatabases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework.ResultsTwenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers.ConclusionsThere are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.

【 授权许可】

CC BY