Diagnosis of dementia
Question 6: Can dementia be diagnosed at first or second level care by non-specialist health care providers? What should be the assessment process for the diagnosis of dementia?
- Population: community-dwelling older people, and older users of primary health care services with probable dementia
- Interventions: diagnosis by non-specialist health care provider (e.g. general practitioner, primary care physician etc) by use of an assessment process/ instrument/protocol
- Comparison: diagnostic assessment process versus no diagnostic assessment process
- the sensitivity and specificity of dementia diagnosis made by non-specialists, among those assessed
- diagnostic documentation rates (the proportion of those with dementia in the population covered by the service provider, with a clinical diagnosis of dementia recorded by the primary care provider)
- the sensitivity, specificity, positive predictive value and negative predictive value of case-finding procedures for dementia in primary care or community settings.
Non-specialist health care providers should seek to identify possible cases of dementia in the primary health care setting and in the community after appropriate training and awareness raising. Brief informant assessment and cognitive tests should be used to assist in confirming these cases. For a formal dementia diagnosis, a more detailed history, medical review and mental state examination should be carried out to exclude other common causes of cognitive impairment and decline. Training should be provided to non-specialist health care providers to diagnose dementia at first or second level health care.
Strength of recommendation: STRONG