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Dementia and Mental Disorders Among the Elderly in Primary Care
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main pmpose of the present thesis was to investigate how elderly patients with dementia and mental disorders were managed in primary care. The prevalence of the disease was investigated, to what extent the patients and their disorders were detected and treated and the approach of general practitioners toward patients with dementia.

Patients aged 70 years and above visiting a primary care centre (PCC) in Linköping (N=1225) were examined with a Mini-Mental Status Examination (MMSE). In a subsample (N=350) a comprehensive neuro psychiatric examination and an interview with a close informant were conducted. All medical records (N=350) in the PCC were reviewed regarding diagnoses, medication and the number of visits to the centre. Dementia and mental disorders were diagnosed according to DSM-III-R. A postal questionnaire was sent out to all general practitioners (GPs) in the county of Östergötland (N=228) to gain information about their situation and attitudes regarding patients with dementia.

Using the traditional cut-off score of 23/24 points in the MMSE, revealed in a considerable under-diagnosing of demented patients in this study, leaving more than 70% of mild cases and 30% of moderate cases undetected. When using a cut-off score of 26/27 good criterion validity was found. There was excellent agreement between the testing by the social worker at the PCC and the GP in the patient's home.

The prevalence of dementia and mental disorder according to the psychiatdc interview was 33% (16% dementia, 17% mental disorders) The frequency of psychiatric symptoms among those with no mental disorder was up to 66%.

Dementia was detected in 25% of cases, depression in 12% of cases and anxiety in 30% of cases. The most common psychiatric diagnosis according to medical records was sleep disorder. Patients with dementia were older, had more other diagnoses as well as medication. Patients with mental disorder had more visits to the PCC.

The GPs underestimated the occurrence of dementia among elderly in PCC. They presented a positive attitude to managing patients with dementia and considered that existing dmg therapy justified an active search for patients with dementia in primary care. Assessment of patients' social enviromnent and the organisation of social support were regarded as the most difficult tasks in the management of demented patients.

The prevalence of dementia and mental disorders in an elderly PCC population is high. As the major problem in the management of dementia and mental disorder has been under-detection, MMSE as an opportunistic screening tool for cognitive function in this group is recommended.

The formation of an effective network, to manage the continuing care of patients with dementia is essential, and a dementia co-ordinator at the PCC would be preferable.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 680
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27532Local ID: 12189ISBN: 91-7219-976-8 (print)OAI: oai:DiVA.org:liu-27532DiVA: diva2:248084
Public defence
2001-05-31, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-07Bibliographically approved
List of papers
1. Detection of Dementia in Primary Care: The Linköping Study
Open this publication in new window or tab >>Detection of Dementia in Primary Care: The Linköping Study
2000 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 11, no 4, 223-229 p.Article in journal (Refereed) Published
Abstract [en]

We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor’s consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.

Keyword
dementia, primary care, detection, prevalence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27074 (URN)10.1159/000017241 (DOI)10867449 (PubMedID)11721 (Local ID)11721 (Archive number)11721 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-07Bibliographically approved
2. Mental Disorders Among Elderly People in Primary Care: The Linköping Study
Open this publication in new window or tab >>Mental Disorders Among Elderly People in Primary Care: The Linköping Study
2001 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 104, no 1, 12-18 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records.

Method: Patients aged 70 years and above attending a primary care centre (N=350) were studied using a psychiatric and medical record examination.

Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17–38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs.

Conclusion: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27073 (URN)10.1034/j.1600-0447.2001.104001012.x (DOI)11720 (Local ID)11720 (Archive number)11720 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-07Bibliographically approved
3. Dementia in Primary Care: Why the Low Detection Rate?
Open this publication in new window or tab >>Dementia in Primary Care: Why the Low Detection Rate?
2001 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, 194-198 p.Article in journal (Refereed) Published
Abstract [en]

Objective - The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs).

Design - Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Östergötland. Setting - Primary care in Sweden.

Main outcome measures - The opinions of GPs on dementia management in primary care.

Results - The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients.

Conclusion - The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26888 (URN)10.1080/028134301316982469 (DOI)11512 (Local ID)11512 (Archive number)11512 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-07Bibliographically approved
4. Mini-Mental State Examination: A Tool for Detecting Dementia in Primary Care?
Open this publication in new window or tab >>Mini-Mental State Examination: A Tool for Detecting Dementia in Primary Care?
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The Mini-mental State Examination (MMSE) is the most widely used test for cognitive function, but its usefulness as a screening tool for dementia has been debated. We investigated the ciiterion validity of the MMSE in patients, aged 70 years and above, attending a piimary care centre (PPC). The MMSE was administered (N=1225) and compared with further diagnosing of dementia according to DSM-III-R in a subgroup (N=350). The major finding was that the use of the traditional cut-off score of 23/24 points on MMSE, left more than 70% of mild cases and 30% of moderate cases undetected. When using a cut-off score of 26/27 a good criterion validity was found and an excellent agreement between the testing by the social worker at the PCC and the general practitioner in the patient's home. As the major problem in the dementia management has been under-detection, we recommend MMSE as an opportunistic screening test in PCC population.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81132 (URN)
Available from: 2012-09-07 Created: 2012-09-07 Last updated: 2012-09-07Bibliographically approved

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