Regular geriatric nurse home visits and physician education may increase dementia diagnoses

Mukadam N, Cooper C, Kherani N, Livingston G. A systematic review of interventions to detect dementia or cognitive impairment Int J Geriatric Psychiatry. 2015; 30:32-45.

Review question

What are the best methods for detecting dementia early and accurately?

Background

Detecting dementia early and accurately can help to improve education, treatment and support for patients and caregivers.  Early diagnoses also help patients and their families plan ahead and allow the patient to be involved in decision-making for their own care. Although many health systems have implemented programs and services to increase patient and care provider education about dementia, not enough is known about which approaches work best to identify people with dementia early and accurately.

How the review was done

This systematic review included any studies which measured impacts of approaches (such as screening, health professional education, and new memory clinics) intended to increase the diagnosis of dementia.  All studies measured the number of people visiting health or social services with memory complaints, the number of new and number of accurate dementia diagnoses among these patients, and the level of cognitive impairment for the people diagnosed with dementia. In all, 13 studies met these criteria, 4 of which were randomized controlled trials. The smallest study included 100 patient referrals from a memory clinic, while the largest studies included population-wide evaluations (eg. distribution of education materials or impacts of new memory clinics within a region or population group).  The results were compared to a control group of patients receiving the usual care, or patients seen before or after the new approaches were in place. 

What the researchers found

Two randomized controlled trials found that physician education increases the number of suspected cases of dementia but not all of these cases were confirmed with a diagnosis.  One randomized controlled trial reported that regular home visits by a geriatric nurse increases the number of accurate dementia diagnoses.  There was some evidence from non-randomized controlled trials that memory clinics may help to identify dementia cases earlier, and that decision support training for health care providers may also be useful. Untargeted leaflet campaigns do not appear to help increase diagnosis rates. The authors recommend more high quality research to determine the best and most cost-effective ways to diagnose dementia early and accurately.

Conclusion

Physician education results in more suspected cases of dementia, but not necessarily accurate or earlier diagnoses.  Regular home visits by a geriatric nurse increase accurate diagnoses; memory clinics may help identify suspected cases earlier.