Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study.
dementia
general practice
medical history taking
sensitivity and specificity
symptom assessment
Journal
BJGP open
ISSN: 2398-3795
Titre abrégé: BJGP Open
Pays: England
ID NLM: 101713531
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
02
04
2021
accepted:
01
06
2021
pubmed:
29
7
2021
medline:
29
7
2021
entrez:
28
7
2021
Statut:
epublish
Résumé
GPs often report using clinical judgment to diagnose dementia. To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia. Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK. The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia. A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
Sections du résumé
BACKGROUND
BACKGROUND
GPs often report using clinical judgment to diagnose dementia.
AIM
OBJECTIVE
To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia.
DESIGN & SETTING
METHODS
Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK.
METHOD
METHODS
The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia.
RESULTS
RESULTS
A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups.
CONCLUSION
CONCLUSIONS
A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
Identifiants
pubmed: 34315715
pii: BJGPO.2021.0058
doi: 10.3399/BJGPO.2021.0058
pmc: PMC8596317
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright © 2021, The Authors.
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