This meta-analysis looked at the ability of general practitioners (GPs) to recognize a spectrum of cognitive impairment from mild cognitive impairment to severe dementia in routine practice using their own clinical judgment.
The authors found 15 studies reporting on dementia, seven studies that examined recognition of broadly defined cognitive impairment, and eight regarding mild cognitive impairment.
By clinical judgment, clinicians were able to identify 73.4% of people with dementia and 75.5% of those without dementia, but they only made correct annotations in medical records in 37.9% of cases (and 90.5% of non-cases).
For cognitive impairment, detection sensitivity was 62.8% by clinician judgment but 33.1% according to medical records. Specificity was 92.6% for those without cognitive impairment by clinical judgment.
GPs recognised only 44.7% of people with mild cognitive impairment. This was recorded in medical notes only 10.9% of the time. Their ability to identify healthy individuals without MCI was between 87.3% and 95.5% (detection specificity).
The authors concluded that:
GPs have considerable difficulty identifying those with mild cognitive impairment and those with mild dementia and are generally poor at recording such diagnoses in medical records.
Mitchell AJ, Meader N, Pentzek M. Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatr Scand. 2011 Jun 11. doi: 10.1111/j.1600-0447.2011.01730.x. [Epub ahead of print] [PubMed abstract]
[…] The symptoms of mild cognitive impairment (MCI) include problems with cognitive functioning such as day-to-day memory. In some individuals it is the first sign of dementia, whereas in others it may be due to resolvable factors such as being the side-effect of medication (Alzheimer’s Society, 2012). At present it is unclear how many people with MCI will go on to develop dementia. The Mental Elf has previously blogged about the importance of early diagnosis and intervention for dementia, as well as the difficulties general practitioners experience in recognising mild cognitive impairment. […]