Sep 23, 2011

Doctors Suck at Diagnosing Dementia, I'm a Healthy Old Broad

Doctors know they aren't good at diagnosing dementia. Alzheimer's caregivers know that doctors are not good at it. A typical Alzheimer's caregiver will say, "looking back I should have known sooner". Put me in that club.

By Bob DeMarco
Alzheimer's Reading Room

I am a healthy old broad
The study below indicates that personal care physicians are not very good at diagnosing dementia.

The study goes on to say over the entire spectrum of memory problems doctors get 3 out of 5. Sounds resonable until you consider the majority of dementia patients get diagnosed when they are already in the moderate to severe stage of Alzheimer's.

Here is a revealing statistic, in general physicians make more false positive diagnoses, than they do "missed" diagnoses. Yikes, is it really Alzheimer's or is it something else?

The simple facts are these, nobody is good at diagnosing dementia. Doctors, lawyers and civilians included.

Doctors know they aren't good at diagnosing dementia. Alzheimer's caregivers know that doctors are not good at it.

A typical Alzheimer's caregiver will say, "looking back I should have known sooner". Put me in that club.

The facts of the matter are, for the most part it is up to us to alert the doctor that something is wrong, very wrong.

By the way, did you learn about Alzheimer's in college? Ever take a course on how to diagnose Alzheimer's? Me either. I doubt that a national effort to educate everyone would solve the problem.

So as I read the statistics below, and other studies that indicate 80 percent of dementia patients don't get diagnosed early on, I have to ask myself? What the hell is wrong with us?

Why don't we start testing everyone over 65 every couple of years? I'll tell you why, because no one wants to pay for it, and personal care physicians (most of them anyway) are not doing it out of the kindness of their heart.

There are some good solutions coming down the pike. In a year or so, there will be a very reliable test available that can run on an IPad.

There are some good tests available free to the public, check them out here -- Test Your Memory for Alzheimer's (5 Best Self Assessment Tests). I'll vote for SAGE.

We have a good article where over 100 readers commented on what they saw as the early signs of dementia -- What Was the First Sign of Alzheimer's Disease in Your Case?

Simple solution, start testing everyone. Will it happen? Maybe once there is a treatment available.

Or maybe sooner. Why? Because pretty soon everyone will fall into one of two categories: either you have Alzheimer's, or you know someone that has Alzheimer's. We are more than halfway there already.

I would be willing to be that not more than 1 out of 10 personal care physicians could diagnose Dotty right now. She is well into the moderate to severe stage.

Don't believe me? Ask Dotty. She will tell you, "I'm a healthy old broad". Every single person we meet for the first time believes it.

So for now it is up to us folks, to help our family and friends.

Subscribe to the Alzheimer's Reading Room

GPs missing early dementia -- new study

People presenting with memory problems and mild dementia are often not diagnosed promptly in primary care

New research from the University of Leicester demonstrates that general practitioners (GPs) are struggling to correctly identify people in the early stages of dementia resulting in both missed cases (false negatives) and misidentifications (false positives).

Researchers from the University of Leicester in the UK and National Collaborating Centre for Mental Health, London, UK and the Department of General Practice, Dusseldorf, Germany examined 30 previous studies involving 15,277 people seen in primary care for cognitive disorders, including 7109 assessed for dementia.

Although GPs managed to identify eight out of ten people with moderate to severe dementia, most patients with early dementia were not recognized. Only 45% of people with early dementia and mild cognitive impairment were identified. Mild cognitive impairment is a condition that may precede dementia in some people.

Across the whole spectrum, GPs identified 3 out of 5 of people attending for broadly defined memory problems.

Dr Alex Mitchell, a consultant psychiatrist with the Leicestershire Partnership NHS Trust and a researcher at the University, said: "This study highlights for the first time that GPs trying to identify dementia actually make more false positive errors, with misidentifications outnumbering missed cases at least two to one."

"GPs working in busy settings struggle to identify early dementia and prodromal conditions based on their initial clinical judgement. This was particularly the case for patients living alone where no informant was available and when patients had relatively preserved daily function. Furthermore, GPs' attitudes towards dementia may play an important role in dementia recognition. A project within the German Competence Network Degenerative Dementias (CNDD) at the University of Dusseldorf is currently investigating this.

"Conversely patients with depression or hearing problems were more at risk of being misidentified with dementia. However, the main influence is severity. Patients with mild dementia may not volunteer troubling memory problems and GPs are often unsure about the value of screening tests. Given the problem of false positives and false negatives we found that the application of a simple cognitive screening test after a clinical diagnosis would help GPs to achieve about 90% accuracy. We report separately which screening test may be best in Am J Geriatr Psychiatry 2010;18:759�."

More Insight and Advice for Caregivers

Original content Bob DeMarco, the Alzheimer's Reading Room