P17. Dementia diagnosis and assessment
Detailed Programme, abstracts and presentations
P17.1. Exploring general practitioners’ perceptions of dementia and how they relate to stigma
Dianne Gove, Murna Downs, Rob Newell and Myrra Vernooij-Dassen
Background: Stigma has been cited as one of the possible barriers to timely diagnosis. General practitioners (GPs) are part of the society in which the stigma of dementia is socially constructed but we know very little about how they perceive dementia. If we are to involve them in awareness raising campaigns or in measures to help reduce the stigma of dementia and thereby improve timely diagnosis, we need to first have a solid understanding of their own perceptions of dementia and how these might relate to stigma. A study was therefore carried out to explore GPs’ perceptions of dementia and how they relate to stigma.
Method: A purposive sample of twenty-three GPs in the north of England took part in semi-structured telephone interviews. The data was collected and analysed qualitatively by means of directed content analysis and framework analysis. A computer programme (Atlas.ti) was used for the management and analysis of the data. The coding of the anonymised transcripts was discussed collectively. The use of pre-determined codes based on current stigma theory helped ensure that all relevant components of stigma were addressed. Data which did not fit into the predetermined codes was coded separately. This helped avoid circularity and permitted the simultaneous exploration of the applicability of the conceptualization of stigma used as a theoretical framework to our understanding of the stigma of dementia.
Findings and implications: In this presentation, I will discuss some of the main findings of this study, highlighting where necessary differences between GPs’ own perceptions of dementia and those they believe lay people to have (e.g. with regard to healthcare discrimination, stereotypes and contributing factors). The results of the study will be interpreted in the light of previous studies involving both lay people and GPs and in relation to current knowledge about stigma. The possible implications for the development of targeted measures to raise awareness not only of lay people but also of GPs will be considered.
P17.2. “Dare to care” dementia. Role of GPs in the diagnosis and treatment of Alzheimer’s disease
Catalina Tudose, Letitia Dobranici, Maria Moglan
Background: In primary care, the diagnosis of dementia is often delayed. Romanian Alzheimer Society Marketing Research (2005) concluded that an action plan would be necessary to encourage early diagnosis.
Aim: 1) To investigate the attitudes and awareness among GPs toward dementia problems; 2) to investigate the practice of GPs in Romania regarding early diagnosis and management of patients with dementia; 3) to identify training or support needs of GPs dealing with dementia issues.
Design of study: Secondary analysis of survey data that capture the above attitudes, awareness, and practice (first survey was made in 2005).
Setting: SRA survey, targeting GPs.
Method: Survey data were obtained using an anonymised questionnaire applied during training sessions organized for them by Romanian Alzheimer Society.
Results: A total of 128 GPs responded. Some of GPs were more confident in diagnosing and giving advice about dementia, but less likely to consider that early diagnosis was beneficial, and more likely to feel that patients with dementia can be a drain of resources with little positive outcome. Other GPs were more positive and felt that much could be done to improve the care system. GPs in general felt they had not had sufficient basic and post-qualifying training in dementia, and overall knowledge about dementia was low, objectives conditions for clinical examination are inappropriate (the duration of clinical examination is 9 minutes).
Conclusion: Much could be done to improve GPs' knowledge and their attitude regarding dementia. The main conclusion is that we shall continue to organize training programs for GPs. The content of the program consists in defining the role of GPs, essential knowledge of dementia simptoms, how to recognize dementia, how to interview patients and their families, how to assess medication requirements and how to explain the disease and treatment to the patients and their families. The paper will discuss an action plan.
Another major task is to do lobby for the recognition of their skills. They need to be more supported and motivated to dare to care dementia.
P17.3. Investigation of subjective memory complaints and objective memory deficit in elderly patients with major depression and mild cognitive impairment
Duman B, Ozel-Kizil ET, Baran Z, Kirici S, Turan E
Objective: Subjective memory complaints (SMC) are frequent in elderly patients with major depression. In this study, we aimed to examine subjective memory complaints and objective memory deficit in elderly patients with major depression (MD), mild cognitive impairment (MCI) and healthy controls (HC).
Method: The study sample consisted of 29 patients with MCI, 30 patients with MD who were consecutively admitted to the Ankara University School of Medicine Department of Psychiatry Geriatric Psychiatry Unit in March-May 2010. HC were 30 volunteers living at nursing homes in Ankara. All subjects were >60 years old. Petersen-Mayo diagnostic criteria were used for the diagnosis of MCI and DSM-IV-TR criteria were used for the diagnosis of MD. Also, all participants were administered Turkish versions of the Mini Mental State Examination (MMSE), ADAS-cog, Subjective memory complaints questionnaire (SMCQ) and Geriatric Depression Scale (GDS).
Results: One-way ANOVA revealed significant difference between groups in terms of SMCQ (MD≈MCI>HC), MMSE (MCI<MD≈HC), GDS (MD>MCI>HC), total ADAS-cog(MCI<MD≈HC), ADAS-cog word memory(MCI<MD≈HC) and word recognition(MCI<MD≈HC) subscale scores. When GDS scores were taken as a covariate, group differences did not change. ANCOVA yielded significant GDS*SMCQ interaction (F=6.44, p=0.01), however GDS*ADAS-cog total and subscale scores were not significant.
Conclusion: SMC which should be taken into consideration in the elderly, seems to be related to depressive symptoms. Patients with MD have similar SMC with MCI patients, however measurements for the objective assessment of memory discriminate patients with MD and MCI. Furthermore, there is no need for the remission of depression in order to test memory dysfunction in elderly patients with MD.
Keywords: Subjective memory complaints, depression, mild cognitive impairment.
Lahr D, Beblo T, Hartje W (2007) Cognitive Performance and Subjective Complaints Before and After Remission of Major Depression. Cognitive Neuropsychiatry; 12 (1),25-45.
Youn JC, Kim KW, Lee DY, Jhoo JH, Lee SB, Park JH, Choi EA, Choe JY, Jeong JW, Choo IH, Woo JI (2009) Development of the Subjective Memory Complaints Questionnaire. Dementia and Geriatric Cognitive Disorders; 27:310-317.
Mavioğlu H, Gedizlioğlu M, Akyel S, Aslaner T, Eser E (2006) The Validity and Reliability of the Turkish version of Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog) in patients with mild and moderate Alzheimer’s disease and normal subjects. International Journal of Geriatric Psychiatry; 21:259-265.
Zakzanis KK, Leach L, Kaplan E (1998) On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology 11(3):111-9.
Tobiansky R, Blizard R, Livingston G, Mann A (1995) The Gospel Oak Study stage IV: the clinical relevance of subjective memory impairment in older people. Psychological Medicine Jul;25 (4): 779- 86.
Mitchell AJ (2008) The Clinical Significance of Subjective Memory Complaints in the diagnosis of mild cognitive impairment and dementia: a meta-anaysis. International Journal of Geriatric Psychiatry; 23: 1191-1202.
P17.4. A dementia assessment clinic model for adults with intellectual disabilities in the Netherlands
Numerous studies have documented that persons with Down’s syndrome show an accelerated ageing and are at increased risk of Alzheimer’s disease. Many of these people live in the community, with parents, brothers and sisters or in small group homes. In the Netherlands, they do not have access to regular healthcare checks, despite the high frequency of common medical complications in adult life. We organised a multidisciplinary outpatient clinic for elderly people with Down’s syndrome. Findings include the most common health problems identified and those considered as risk factors associated with or aggravating dementia.
Last Updated: Wednesday 26 October 2011