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Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from Australia

Published online by Cambridge University Press:  25 November 2019

Christopher M. Black ,
Michael Woodward ,
Baishali M. Ambegaonkar ,
Alana Philips ,
James Pike ,
Eddie Jones ,
Joseph Husbands  and
Rezaul K. Khandker
Christopher M. Black*
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
Michael Woodward
Affiliation:
Aged Care Services and Head, Aged Care Research, Memory and Wound Clinics, Austin Health, Heidelberg, Victoria, Australia
Baishali M. Ambegaonkar
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
Alana Philips
Affiliation:
MSD, Sydney, NSW, Australia
James Pike
Affiliation:
Adelphi Real World, Macclesfield, UK
Eddie Jones
Affiliation:
Adelphi Real World, Macclesfield, UK
Joseph Husbands
Affiliation:
Adelphi Real World, Macclesfield, UK
Rezaul K. Khandker
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
*
Correspondence should be addressed to: Christopher M. Black, Outcomes Research, Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA. Phone: +732 594-3037. Email: christopher.black2@merck.com.
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Abstract

Objectives:

Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.

Design:

A real-world, cross-sectional survey of physicians and patients.

Setting:

Clinical practice.

Participants:

Primary care or specialist physicians managing patients with cognitive impairment (CI).

Measurements:

Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.

Results:

Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.

Conclusions:

A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.

Keywords

caregiverscognitive impairmentearly diagnosisprodromalreal-world
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 5: Issue Theme: Challenges and Facilitators for Diagnosis and Treatment of Dementia , May 2020 , pp. 601 - 610
Copyright
© International Psychogeriatric Association 2019

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References

Alzheimer’s Disease International. (2016). World Alzheimer Report. Available at: https://www.alz.co.uk/research/WorldAlzheimerReport2016.pdf; accessed 30 Mar 2018.Google Scholar
Alzheimer’s Society. (2014). Dementia UK: Update. Available at: https://www.alzheimers.org.uk/download/downloads/id/2323/dementia_uk_update.pdf; accessed 11 Apr 2018.Google Scholar
Anderson, P., Benford, M., Harris, N., Karavali, M. and Piercy, J. (2008). Real-world physician and patient behaviour across countries: disease-specific programmes – a means to understand. Current Medical Research and Opinion, 24, 3063–3072.CrossRefGoogle ScholarPubMed
Arevalo-Rodriguez, I.et al. (2015) Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database of Systematic Reviews, 3, CD010783.Google Scholar
Bondi, M., Jal, A., Delano-Wood, L., Jacobson, M., Delis, D. and Salmon, D. (2008) Neuropsychological contributions to the early identification of Alzheimer’s disease. Neuropsychology Review, 18, 73–90.CrossRefGoogle ScholarPubMed
Brodaty, H., Connors, M. H., Ames, D. and Woodward, M. (2014) PRIME study group. Progression from mild cognitive impairment to dementia: a 3-year longitudinal study. Australian and New Zealand Journal of Psychiatry, 48, 1137–1142.CrossRefGoogle Scholar
Crimmins, E. M., Kim, J. K., Langa, K. M. and Weir, D. R. (2011). Assessment of cognition using surveys and neuropsychological assessment: the health and retirement study and the aging, demographics, and memory study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 66 Suppl 1, 162–171.CrossRefGoogle ScholarPubMed
Cummings, J. L., Dubois, B., Molinuevo, J. L. and Scheltens, P. (2013). International work group criteria for the diagnosis of Alzheimer disease. Medical Clinics of North America, 97, 363–368.CrossRefGoogle Scholar
Dementia Australia. (2018). Dementia Statistics. Available at: https://www.dementia.org.au/statistics; accessed 27 Apr 2018.Google Scholar
Draper, B.et al. (2016). Time to diagnosis in young-onset dementia and its determinants: the INSPIRED study. International Journal of Geriatric Psychiatry, 31, 1217–1224.CrossRefGoogle ScholarPubMed
Dyer, S. M., Laver, K., Pond, C. D., Cumming, R. G., Whitehead, C. and Crotty, M. (2016). Clinical practice guidelines and principles of care for people with dementia in Australia. Australian Family Physician, 45, 884–889.Google ScholarPubMed
Eleti, S. (2016). Drugs in Alzheimer’s disease Dementia: an overview of current pharmacological management and future directions. Psychiatria Danubina, 28, 136–140.Google ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Jack, C. R., Jret al. (2011). Introduction to the recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 257–262.CrossRefGoogle ScholarPubMed
Lathren, C. R., Sloane, P. D., Hoyle, J. D., Zimmerman, S. and Kaufer, D. I. (2013). Improving dementia diagnosis and management in primary care: a cohort study of the impact of a training and support program on physician competency, practice patterns, and community linkages. BMC Geriatrics, 13, 134.CrossRefGoogle ScholarPubMed
Laver, K.et al. (2016). Clinical practice guidelines for dementia in Australia. Medical Journal of Australia, 204, 191–193.CrossRefGoogle ScholarPubMed
Mielke, M. M., Vemuri, P. and Rocca, W. A. (2014). Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clinical Epidemiology, 6, 37–48.CrossRefGoogle ScholarPubMed
Moise, P., Schwarzinger, M., Um, M.-Y., and the Dementia Experts’ Group. (2004). Dementia Care in 9 OECD Countries: A Comparative Analysis. Available at: https://www.oecd.org/els/health-systems/33661491.pdf; accessed 11 Apr 2018.Google Scholar
Niu, H., Álvarez-Álvarez, I., Guillén-Grima, F. and Aguinaga-Ontoso, I. (2017). Prevalence and incidence of Alzheimer’s disease in Europe: a meta-analysis. Neurologia, 32, 523–532.CrossRefGoogle ScholarPubMed
Olazarán, J.et al. (2010). Nonpharmacological therapies in Alzheimer’s disease: a systematic review of efficacy. Dementia and Geriatric Cognitive Disorders, 30, 161–178.CrossRefGoogle Scholar
Parkin, E. and Baker, C. (2016). Dementia: Policy, Services and Statistics. Commons Briefing Paper SN07007. Available at: http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN07007#fullreport; accessed 30 Mar 2018.Google Scholar
Parmar, J.et al. (2014). Diagnosis and management of dementia in primary care. Canadian Family Physician, 60, 457–465.Google ScholarPubMed
Perry-Young, L., Owen, G., Kelly, S. and Owens, C. (2016). How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography. Dementia (London), pii: 1471301215626889. [Epub ahead of print].Google Scholar
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2009). Early diagnosis of Alzheimer’s disease: is MCI too late? Current Alzheimer Research, 6, 324–330.CrossRefGoogle ScholarPubMed
Petersen, R. C.et al. (2001). Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology, 56, 1133–1142.CrossRefGoogle ScholarPubMed
Ritchie, C. W.et al. (2018). Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from seven European and North American countries. Journal of Alzheimer’s Disease, 62, 457–466.CrossRefGoogle ScholarPubMed
Samus, Q. M. et al. (2014). A multidimensional home-based care coordination intervention for elders with memory disorders: the maximizing independence at home (MIND) pilot randomized trial. The American Journal of Geriatric Psychiatry, 22, 398–414.CrossRefGoogle ScholarPubMed
Sousa, R.et al. (2009). Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia research group population-based survey. Lancet, 374, 1821–1830.CrossRefGoogle Scholar
Speechly, C. M., Bridges-Webb, C. and Passmore, E. (2008). The pathway to dementia diagnosis. Medical Journal of Australia, 189, 487–489.CrossRefGoogle ScholarPubMed
StataCorp. (2015). Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.Google Scholar
Strivens, E. and Craig, D. (2014). Managing dementia-related cognitive decline in patients and their caregivers. Aust Fam Physician, 43, 170–174.Google ScholarPubMed
Suvarna, V. (2018). Real world evidence (RWE) – are we (RWE) ready? Perspectives in Clinical Research, 9, 61–63.CrossRefGoogle ScholarPubMed
van Vliet, D.et al. (2013). Time to diagnosis in young-onset dementia as compared with late-onset dementia. Psychological Medicine, 43, 423–432.CrossRefGoogle ScholarPubMed
Waite, L. M. (2015). Treatment for Alzheimer’s disease: has anything changed? Australian Prescriber, 38, 60–63.CrossRefGoogle ScholarPubMed
Weller, J. and Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Res, 7, pii: F1000 Faculty Rev-1161.Google Scholar
Wilkinson, D., Stave, C., Keohane, D. and Vincenzino, O. (2004). The role of general practitioners in the diagnosis and treatment of Alzheimer’s disease: a multinational survey. Journal of International Medical Research, 32, 149–159.CrossRefGoogle ScholarPubMed
Workman, B., Dickson, F. and Green, S. (2010). Early dementia – optimal management in general practice. Australian Family Physician, 39, 722–726.Google ScholarPubMed
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