Missed and delayed diagnosis of dementia in primary care: Prevalence and contributing factors

Andrea Bradford, Mark E. Kunik, Paul Schulz, Susan P. Williams, Hardeep Singh

Research output: Contribution to journalReview articlepeer-review

616 Scopus citations

Abstract

Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.

Original languageEnglish (US)
Pages (from-to)306-314
Number of pages9
JournalAlzheimer Disease and Associated Disorders
Volume23
Issue number4
DOIs
StatePublished - Oct 2009

Keywords

  • Dementia
  • Diagnostic errors
  • Primary care

ASJC Scopus subject areas

  • Clinical Psychology
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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