GPs find it difficult to identify mild cognitive impairment and mild dementia, and are poor at recording diagnoses

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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]

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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