GP Confidence in diagnosing Dementia

Dr. Annelind Hurst, Inverurie Medical Group 2014

BackgroundThe world Alzheimer Report 2009 estimated that 36 million people worldwide currently suffer from dementia. This is predicted to increase to 66 million people in 2030 and 155 million by 2050. This will place an increased burden on secondary care to diagnose dementia and it maybe that “straight forward” diagnosis of dementia will be made by GP’s in the community in the future.

MethodIn order to gauge current GP confidence in diagnosis dementia I developed a questionnaire which was distributed to all present GPs in my practice.16 questionnaires were distributed, 14 were received back, evenly distributed between male and female GPs and a wide variety in age and experience .

ResultsScale of 1 – 10. 1= not confident at all /10 = very confident How confident do you feel currently in diagnosing dementia without any input by old age psychiatry? How confident do you feel to interpret a scan result ?

How confident would you feel making the diagnosis with?A) a supportive history from family / carersB) normal blood resultsC) a scan result (CT or SPECT)

Would you be happier to make a diagnosis if a specific type of dementia is suspected?D) Vascular dementia is suspectedE) Alzheimer's dementia is suspectedF) Mixed type dementia is suspected

What would be required to increase your confidence?“Increased training, positive scan reports, accessible practice based resource, more time to spend with patient and family”“having more than 10min appointments”“guidelines or some criteria for referral”“although I am happy with initially assessment, full assessment and diagnosis takes time I’m not sure we have. Very important to get diagnosis right and have access to support”“training re interpretations of scans especially SPECT”“training re interpretation of scans, training re diagnosis of dementia”“training, education and support”

Would you be happy to refer to a GP who has completed the scholarship to make a diagnosis?

Evaluation / CommentCurrently GPs feel relatively confident to make a diagnosis of dementia (6 of scale of 1 to 10), however much less so in interpreting a scan result.The confidence seems to be improved mostly with a positive family history while normal blood results or a scan result does not seem to improve the confidence any more.The confidence to make a diagnosis of a specific type of dementia seems to be slightly less (5 vs. 6) than a general diagnosis, this is worst for a diagnosis of mixed type dementia (3 vs. 4/5 for vascular and Alzheimer’s dementia).The requirements to increase confidence vary widely from increased time for assessment, over need for more training in both diagnosis of dementia and interpreting scan results. Well reported scan results would be helpful. However, input from old age psychiatry should not be lost with one comment pointing out the importance of getting the diagnosis right as obviously huge impact on patients and their family’s lives.The dementia scholarship generally is felt to be a good opportunity to increase knowledge in one member of the team, which then can be either cascaded down or be used for initial advice.Overall I was surprised that the majority of GPs actually seem to be quite confident to make an initial diagnosis of dementia without the input of old age psychiatry and a well reported scan may increase this further .It may also then increase the confidence to diagnose a certain type of dementia. Support from the old age psychiatrist is very useful and should not be lost.

Learning points for meA good history with supportive history from family / friends is more useful in the diagnosis of dementia than a brain scan.There is a lot of support for patients by CPNs, support workers, OTs etc going on behind the scenes that I, as a GP, may not be aware of at all.I have enjoyed meeting all the different members of the dementia team and find out more about their roles.

.

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10

Number

of

GPs

Confidence

making diagnosis

interpreting scan result

0

1

2

3

4

5

6

1 2 3 4 5 6 7 8 9 10

number

of

GPs

confidence

with supportive history

with normal bloods

with scan result

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10

Number

of

GPs

Confidence

vascular dementia suspected

Alzheimers suspected

Mixed dementia suspected

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10

Number

of

GPs

happy to refer to GP after scholarship completion