Frequency and diagnostic utility of cognitive test instrument use by GPs prior to memory clinic referral.

Abstract

BACKGROUND: Previous studies have indicated not only that cases of dementia are missed in primary care but also that many non-demented patients are referred for evaluation to secondary care. OBJECTIVES: To measure frequency of cognitive test instrument use in primary care prior to patient referral to secondary care and to assess the relationship between instrument use and ultimate diagnosis. METHODS: This was a prospective study conducted in a Cognitive Function Clinic, Regional Neuroscience Centre setting. The referral letters for all patients seen in the clinic over a 2-year period (n = 231) were examined for mention of cognitive test instrument use. Patients were evaluated by standard clinical, neuropsychological and neuroimaging methods and diagnoses were made according to widely accepted diagnostic criteria for dementia and dementia subtype. Primary care cognitive test use and final diagnosis were then compared. RESULTS: Evidence of cognitive test use in primary care was found in 20% of referrals. Patients evaluated with cognitive test instruments in primary care were more likely to receive a diagnosis of dementia, whereas those not tested were more likely to receive a diagnosis of 'not demented'. CONCLUSIONS: Use of simple cognitive test instruments in primary care may improve dementia diagnosis and reduce the rate of referral of non-demented patients.