Skip to main content

Advertisement

Log in

General Practitioners’ Judgment of their Elderly Patients’ Cognitive Status

  • Brief Report
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

General practitioners (GP) play an important role in detecting cognitive impairment among their patients.

Objectives

To explore factors associated with GPs’ judgment of their elderly patients’ cognitive status.

Design

Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers.

Participants

138 GPs, 3,181 patients (80.13 ± 3.61 years, 65.23% female).

Measurements

General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs’ judgment of “cognitively impaired” vs. “cognitively unimpaired.”

Results

Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35–4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13–1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35–12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08–1.22) were more likely to be rated as “cognitively impaired” by their GPs.

Conclusions

The associations between GPs’ assessments of cognitive impairment and their familiarity with their patients and patients’ mobility, hearing, and morbidity provide important insights into how GPs make their judgments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Panza F, D’Introno A, Colacicco AM, et al. Current epidemiology of mild cognitive impairment and other predementia syndromes. Am J Geriatr Psychiatry. 2005;13:633–44.

    PubMed  Google Scholar 

  2. Downs M. The role of general practice and the primary care team in dementia diagnosis and management. Int J Geriatr Psychiatry. 1996;11:937–42.

    Article  Google Scholar 

  3. Linden M, Horgas AL, Gilberg R, Steinhagen-Thiessen E. Predicting health care utilization in the very old: the role of physical health, mental health, attitudinal and social factors. J Aging Health. 1997;9:3–27.

    Article  CAS  PubMed  Google Scholar 

  4. Schers HJ, van den Hoogen H, Bor H, Grol R, van den Bosch W. Familiarity with a GP and patients’ evaluations of care. A cross-sectional study. Fam Pract. 2005;22:15–9.

    Article  PubMed  Google Scholar 

  5. Chodosh J, Petitti DB, Elliott M, et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc. 2004;52:1051–9.

    Article  PubMed  Google Scholar 

  6. Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160:2964–8.

    Article  CAS  PubMed  Google Scholar 

  7. Luck T, Riedel-Heller SG, Kaduszkiewicz H, et al. Mild cognitive impairment in general practice: age-specific prevalence and correlate results from the German Study on Ageing, Cognition and Dementia in primary care patients (AgeCoDe). Dement Geriatr Cogn Disord. 2007;24:307–16.

    Article  PubMed  Google Scholar 

  8. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139:1136–9.

    CAS  PubMed  Google Scholar 

  9. Zaudig M, Hiller W. SIDAM-Handbuch. Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multi-Infakrt- (oder vaskulären) Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD-10. Bern: Hans Huber; 1996.

    Google Scholar 

  10. Lawton MP, Brody EM. The instrumental activities of daily living scale. Gerontologist. 1969;9:179–86.

    CAS  PubMed  Google Scholar 

  11. Sheikh JI, Yesavage JA. Geriatrie Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–73.

    Article  Google Scholar 

  12. Geerlings MI, Jonker C, Bouter LM, Adèr HJ, Schmand B. Association between memory complaints and incident Alzheimer's disease in elderly people with normal baseline cognition. Am J Psychiatry. 1999;156:531–7.

    CAS  PubMed  Google Scholar 

  13. Jorm AF, Christensen H, Korten AE, Jacomb PA, Henderson AS. Memory complaints as a precursor of memory impairment in older people: a longitudinal analysis over 7–8 years. Psychol Med. 2001;31:441–9.

    CAS  PubMed  Google Scholar 

  14. Brauns H, Steinmann S. Educational reform in France, West Germany, and the United Kingdom. ZUMA-Nachrichten. 1999;44:7–44.

    Google Scholar 

  15. Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment: beyond controversies, towards a consensus: report for the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256:240–6.

    Article  CAS  PubMed  Google Scholar 

  16. Wind AW, Schellevis FG, van Staveren G, et al. Determinants of the judgment of general practitioners on dementia. Int J Geriatr Psychiatry. 1995;10:767–76.

    Article  Google Scholar 

  17. MacKnight C, Graham J, Rockwood K. Factors associated with inconsistent diagnosis of dementia between physicians and neuropsychologists. J Am Geriatr Soc. 1999;47:1294–9.

    CAS  PubMed  Google Scholar 

  18. Aldrich CK. The medical interview, 2nd ed. New York: Parthenon Publishing; 1999.

    Google Scholar 

  19. Weyrauch KF. The role of physicians' personal knowledge of the patient in clinical practice. J Fam Pract. 1995;40:249–56.

    CAS  PubMed  Google Scholar 

  20. Kinmonth AL, Stewart M. The patient-doctor relationship. In: Jones R, Britten N, Culpepper L, et al, eds. The Oxford Textbook of Primary Medical Care, Volume . Oxford, UK: Oxford University Press; 2005; 1: 169–73.

    Google Scholar 

Download references

Acknowledgements

The authors thank all participating patients and their general practitioners for their good collaboration.

GPs who recruited patients into the study are listed below:

Hamburg: Gundula Bormann, Winfried Bouché, Doris Fischer-Radizi, Michael Funke, Heike Gatermann, Wolfgang Herzog, Petra Hütter, Stefanie Kavka-Ziegenhagen, Günther Klötzl, Bernd-Uwe Krug, Dietrich Lau, Ursula Linn, Andrea Moritz, Karl-Christian Münter, Detlef Niemann, Klaus Richard-Klein, Walter Schreiber, Ursula Schröder-Höch, Gerhard Schulze, Klaus Stelter, Carl-Otto Stolzenbach, Ljudmila Titova, Klaus Weidner, Otto-Peter Witt, Eckehard Zeigert;

Mannheim: Gerhard Arnold, Veit-Harold Bauer, Werner Besnier, Hanna Böttcher-Schmidt, Hartmut Grella, Gernot Kunzendorf, Ingrid Ludwig, Manfred Mayer, Hubert Mühlig, Arnt Müller, Adolf Noky, Helmut Perleberg, Carsten Rieder, Michael Rosen, Georg Scheer, Michael Schilp, Matthias Schneider, Jürgen Wachter, Brigitte Weingärtner, Hans-Georg Willhauck;

Bonn: Jörg Eimers-Kleene, Klaus Fischer, Maria Goebel-Schlatholt, Peter Gülle, Wolf-Dietrich Honig, Hans Jürgen Kaschell, Hanna Liese, Manfred Marx, Eberhard Prechtel, Heinz-Peter Romberg, Heribert Schützendorf, Annemarie Straimer, Martin Tschoke, Karl-Michael Werner;

Halstenbek: Herrmut Mayen;

Königswinter: Theodor Alfen;

Bad Honnef: Klaus Weckbecker;

Niederkassel: Inge Bürfent;

Alfter-Oedekoven: Johann von Aswege;

Erfstadt-Liblar: Arndt Uhlenbrock;

Windeck-Herchen: Wolf-Rüdiger Weisbach;

Leipzig: Martina Amm, Heinz-Michael Assmann, Horst Bauer, Barbara Bräutigam, Jochen Ebert, Angelika Gabriel, Eva Hager, Gunter Kässner, Ina Lipp, Thomas Lipp, Ute Mühlmann, Gabi Müller, Thomas Paschke, Gabriele Rauchmaul, Ina Schmalbruch, Holger Schmidt, Hans-Christian Taut, Ute Voß, Bettina Winkler, Sabine Ziehbold;

München: Eugen Allwein, Guntram Bloß, Peter Dick, Johann Eiber, Lutz-Ingo Fischer, Peter Friedrich, Helga Herbst, Andreas Hofmann, Günther Holthausen, Karl-Friedrich Holtz, Ulf Kahmann, Elke Kirchner, Hans Georg Kirchner, Luitpold Knauer, Andreas Koeppel, Heinz Koschine, Walter Krebs, Franz Kreuzer, Karl Ludwig Maier, Christoph Mohr, Elmar Schmid, Gabriel Schmidt, Johann Thaller;

Haar: Richard Ellersdorfer, Michael Speth;

Düsseldorf: Angela Ackermann, Pauline Berger, Florinela Cupsa, Barbara Damanakis, Klaus-Wolfgang Ebeling, Tim Oliver Flettner, Michael Frenkel, Friederike Ganßauge, Kurt Gillhausen, Hans-Christian Heede, Uwe Hellmessen, Benjamin Hodgson, Bernhard Hoff, Helga Hümmerich, Boguslaw-Marian Korman, Dieter Lüttringhaus, Dirk Matzies, Vladimir Miasnikov, Wolfgang Josef Peters, Birgitt Richter-Polynice, Gerhard Erich Richard Schiller, Ulrich Schott, Andre Schumacher, Harald Siegmund, Winfried Thraen, Roland Matthias Unkelbach, Clemens Wirtz.

Conflict of Interest

All authors declare that the answer to all questions on the competing interest form is “No” and therefore have nothing to declare.

Funding

The German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe) is part of the German Competence Network Dementia (KND) and the German Competence Network Degenerative Dementias (KNDD) and was funded by the German Federal Ministry of Education and Research (grants KND: 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433, 01GI0434; KNDD: 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716).

Authorship Statement

HK, MP, ME, HvB, and WM contributed to study conception and design; all authors contributed to recruitment of GPs and patients, data acquisition, analysis and interpretation; BW organized data management and assured data quality; BW and MP performed the biostatistical analyses based on the discussions of all authors; MP, ME, and HK drafted the article; AF and AW critically discussed all versions of the manuscript; all authors revised and finally approved the version to be published.

Sponsor’s Role

Funding had no influence on design, methods, subject recruitment, data collection, analysis, or preparation of the paper.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding authors

Correspondence to Michael Pentzek ScD or Marion Eisele MSc.

Additional information

Further members of the AgeCoDe Study Group: Heinz-Harald Abholz, Cadja Bachmann, Michaela Buchwald, Mirjam Colditz, Moritz Daerr, Sandra Eiffländer-Gorfer, Sven Heinrich, Frank Jessen, Teresa Kaufeler, Hans-Helmut König, Tobias Luck, Melanie Luppa, Manfred Mayer, Julia Olbrich, Heinz-Peter Romberg, Anja Rudolph, Melanie Sauder, Britta Schuermann, Michael Wagner, Anja Wollny, and Thomas Zimmermann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pentzek, M., Fuchs, A., Wiese, B. et al. General Practitioners’ Judgment of their Elderly Patients’ Cognitive Status. J GEN INTERN MED 24, 1314–1317 (2009). https://doi.org/10.1007/s11606-009-1118-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1118-2

KEY WORDS

Navigation