Article Figures & Data
Figures
- Figure 1. Inclusion flowchart. Reasons of referral other than cognitive analysis included analysis of functional decline (n = 4), functional decline and falls (n = 2), treatment advice for dementia, mild cognitive impairment, or persistent acoustic hallucinations (n = 3), and other (n = 8).
- Figure 2. Proportion of people diagnosed with dementia by number of diagnostic criteria present in GP referral letters
Tables
- Table 1. Diagnostic dementia criteria formulated in the Dutch GP dementia guidelines, translated from Dutch to English
Cognitive or behavioural symptoms that: 1. Interfere with daily functioning 2. Represent a decline from previous levels of functioning and performing 3. Are not explained by delirium or depression 4. Are diagnosed based on (collateral) history-taking and objectified by a cognitive test (MMSE and clock-drawing test or RUDAS) 5. Involve ≥2 of the following domains: Impaired ability to acquire and remember new information
Impaired reasoning and handling of complex tasks; poor judgement
Impaired visuospatial abilities
Impaired language functions
Changes in personality or behaviour
MMSE = Mini-Mental State Examination. RUDAS = Rowland Universal Dementia Assessment Scale.
Characteristic Total, N = 651 Dementia, n = 348 MCI, n = 156 SMCs, n = 71 Inconclusive, n = 50 Other, n = 26 Age, years, mean (SD) 78.0 (6.8) 79.8 (6.6) 76.8 (5.9) 73.5 (6.8) 77.6 (6.1) 73.8 (7.4) Sex, female 348 (53.5) 199 (57.2) 77 (49.4) 28 (39.4) 31 (62.0) 13 (50.0) Education level Low
Moderate
High
Unknown126 (19.4)
283 (43.5)
186 (28.6)
56 (8.6)82 (23.6)
162 (46.6)
77 (22.1)
27 (7.8)19 (12.2)
64 (41.0)
58 (37.2)
15 (9.6)8 (11.3)
23 (32.4)
32 (45.1)
8 (11.3)14 (28.0)
23 (46.0)
10 (20.0)
3 (6.0)3 (11.5)
11 (42.3)
9 (34.6)
3 (11.5)Marital status Married
Divorced
Widow(er)
Other
Unknown341 (52.4)
45 (6.9)
201 (30.9)
60 (9.2)
4 (0.6)176 (50.6)
15 (4.3)
132 (37.9)
25 (7.2)
0 (0.0)85 (54.5)
10 (6.4)
39 (25.0)
20 (12.8)
2 (1.3)48 (67.6)
6 (8.5)
6 (8.5)
10 (14.1)
1 (1.4)18 (36.0)
12 (24.0)
17 (34.0)
3 (6.0)
0 (0.0)14 (53.8)
2 (7.7)
7 (26.9)
2 (7.7)
1 (3.8)Living situation Alone
With others
Other
Unknown280 (43.0)
352 (54.1)
14 (2.2)
5 (0.8)164 (47.1)
176 (50.6)
7 (2.0)
1 (0.3)62 (39.7)
88 (56.4)
5 (3.2)
1 (0.6)18 (25.4)
51 (71.8)
0 (0.0)
2 (2.8)23 (46.0)
24 (48.0)
2 (4.0)
1 (2.0)13 (50.0)
13 (50.0)
0 (0.0)
0 (0.0)Receives home care Yes
No
Unknown142 (21.8)
435 (66.8)
74 (11.4)99 (28.4)
224 (64.4)
25 (7.2)20 (12.8)
111 (71.2)
25 (16.0)4 (5.6)
56 (78.9)
11 (15.5)14 (28.0)
30 (60.0)
6 (12.0)5 (19.2)
14 (53.8)
7 (26.9)Receives informal care Yes
No
Unknown389 (59.8)
80 (12.3)
182 (28.0)271 (77.9)
24 (6.9)
53 (15.2)61 (39.1)
29 (18.6)
66 (42.3)11 (15.5)
17 (23.9)
43 (60.6)35 (70.0)
5 (10.0)
10 (20.0)11 (42.3)
5 (19.2)
10 (38.5)Comorbidities Total, mean (SD)
History of depression3.4 (2.1)
85 (13.1)3.4 (2.1)
34 (9.8)3.3 (2.6)
19 (12.2)2.9 (2.0)
15 (21.1)3.5 (2.0)
8 (16.0)3.5 (1.9)
9 (34.6)Total number of medications, mean (SD) 5.0 (3.7) 5.2 (3.6) 4.9 (3.9) 3.9 (3.1) 5.9 (3.8) 5.6 (4.4) Data are presented as n (%) unless otherwise stated. MCI = mild cognitive impairment. SD = standard deviation. SMCs = subjective memory complaints.
- Table 3. Presence of diagnostic workup elements in GP referral letters by diagnostic outcome
Workup element Dementia, n = 348 No dementia, n = 303 P value Dementia without AI, n = 235 Dementia with AI, n = 113 P value Patient’s history 305 (87.6) 277 (91.4) 0.119 205 (87.2) 100 (88.5) 0.738 Collateral history 278 (79.9) 175 (57.8) <0.001 188 (80.0) 90 (79.6) 0.939 Physical exam 98 (28.2) 60 (19.8) 0.013 69 (29.4) 29 (25.7) 0.473 Neurological exam 26 (7.5) 29 (9.6) 0.337 11 (4.7) 15 (13.3) 0.004 Blood test 94 (27.0) 75 (24.8) 0.512 66 (28.1) 28 (24.8) 0.515 DD dementia mentioned 197 (56.6) 117 (38.6) <0.001 137 (58.3) 60 (53.1) 0.359 MMSE performed 149 (42.8) 103 (34.0) 0.021 98 (41.7) 51 (45.1) 0.545 MMSE, performed score, mean (SD) 23.7 (3.9) 25.7 (3.3) <0.001 23.4 (4.1) 24.3 (3.3) 0.210 Time to referral, months, mean (SD)a 6.0 (13.3) 3.8 (8.9) 0.003 6.1 (13.6) 5.8 (12.7) 0.893 Data are presented as n (%) unless otherwise stated. aTime from first consultation to referral based on first contact mentioned in referral letter and referral letter date. AI = ancillary investigations. DD = differential diagnosis. MMSE = Mini-Mental State Examination. SD = standard deviation.
- Table 4. Presence of diagnostic dementia criteria in GP referral letters by diagnostic outcome
Diagnostic dementia criterium Dementia, n = 348 No dementia, n = 303 P value Dementia without AI, n = 235 Dementia with AI, n = 113 P value Symptoms interfere with daily functioning 152 (43.7) 78 (25.7) <0.001 112 (47.7) 40 (35.4) 0.031 Symptoms represent decline from previous levels of functioning 232 (66.7) 154 (50.8) <0.001 159 (67.7) 73 (64.6) 0.571 Symptoms not explained by delirium or depression 7 (2.0) 7 (2.3) 0.618 1 (0.4) 6 (5.3) N/Aa Symptoms diagnosed based on history-taking and cognitive test 71 (20.4) 30 (9.9) 0.002 47 (20.0) 24 (21.2) 0.788 Cognitive impairment in ≥2 domains 219 (62.9) 133 (43.9) <0.001 218 (92.8) 106 (93.8) 0.720 ≥2 diagnostic criteria present 217 (62.4) 125 (41.3) <0.001 148 (63.0) 69 (61.1) 0.730 ≥3 diagnostic criteria present 130 (37.4) 49 (16.2) <0.001 93 (39.6) 37 (32.7) 0.217 Data are presented as n (%) unless otherwise stated. aN/A = not applicable; groups too small for statistical testing, n = 7. AI = ancillary investigations.
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Diagnostic information in GP referral letters to a memory clinic: a retrospective cohort study
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