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Family Practice Advance Access originally published online on September 7, 2007
Family Practice 2007 24(6):616-621; doi:10.1093/fampra/cmm046
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Diagnosing dementia with confidence by GPs

Hein PJ van Houta, Myrra J Vernooij-Dassenb and Wim AB Stalmana

a Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center Amsterdam, Amsterdam, The Netherlands
b Center for Quality of Care Research (WOK), University Medical Center St Radboud, Nijmegen, The Netherlands

Correspondence to Hein van Hout, Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center Amsterdam, Van der Boechorststraat 7 1081 BS Amsterdam, The Netherlands; Email: hpj.vanhout{at}vumc.nl

Received 7 March 2007; Accepted 4 July 2007.


  Abstract

Background. Earlier reports suggest limited clinical reasoning and substantial uncertainty of GPs in assessing patients suspected of dementia.

Objective. To explore the predictors of GPs to decide on the presence and absence of dementia as well as the predictors of diagnostic confidence of GPs.

Design. An observational study was set up among 107 patients of 64 GPs. The GPs were instructed to use the Dutch national dementia guideline on consecutive patients newly suspected of dementia and to register their assessment on a detailed form. The predictors of the presence and absence of dementia according to the GPs and their diagnostic confidence were explored by logistic regression analyses.

Main outcome measures. Dependent variables: (i) presence and absence of dementia according to GPs and (ii) diagnostic confidence.

Independent variables: clinical (cognitive, behavioural, somatic, functional), applications of recommendations, patient related and GP related.

Results. Dementia was diagnosed in 67% of the suspected patients. The presence of dementia according to the GPs was positively associated with observed impairment of the higher cognitive functions, absence of depression and female gender of patients. The GPs expressed diagnostic confidence in 58% of the cases. This was positively associated with application of recommendations, ADL dependency, longer duration, informant availability, restless behaviour and a patient's female gender. Use of the Mini Mental Status Examination was not associated with confidence.

Conclusions. GPs seem to base the diagnosis of dementia on rational grounds. Application of the dementia guideline's recommendations may contribute to more diagnostic confidence.

Keywords. Clinical diagnosis, decision science, dementia, diagnostic tests, family medicine.

van Hout HPJ, Vernooij-Dassen MJ and Stalman WAB. Diagnosing dementia with confidence by GPs. Family Practice 2007; 24: 616–621.


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