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