Detecting Dementia during Primary Care Visits

October 24, 2019
Detecting dementia during a primary care visit is very important for making sure the patient gets the treatment they need. Today, we'll talk about why an early diagnosis can be so important.

If someone has signs of cognitive decline, it’s important that they see a specialist who can provide a full diagnosis. Likewise, detecting dementia during a primary care visit can be the key to delaying the illness’s progress and loss of autonomy. In the case of cognitive decline, early detection can help significantly slowing its progress.

As Pastor et al. (2003) argue, late diagnosis of dementia can have consequences for the quality of life of patients and their families. On the other hand, symptoms that a physician observes during a primary care visit could be the result of a temporary condition. Consequently, a thorough differential diagnosis is very important.

Why is early detection so important?

On the flip side, early diagnosis can make it easy to identify the causes of the disease. As a result, if the patient is suffering from a type of reversible dementia, they would have time to get the proper treatment. It also facilitates the adoption of pharmacological and behavioral measures that have been shown to be effective in maintaining cognitive function.

Also, detecting dementia early allows the family to adapt to the news little by little. It can be hard for families to deal with the changes that dementia brings, so having time to process the information can potentially reduce stress.

“It’s far more important to know what person the disease has than what disease the person has.”

-Hippocrates-

An older woman looking out the window.

Warning signs

Arenillas et al. (2018) divided the warning signs of dementia into three categories: cognitive, behavioral, psychological, and functional. The main cognitive signs that are useful for detecting dementia are the following:

  • Difficulty remembering recent events, routes, or names. Forgetting messages, or repeating the same question over and over.
  • Trouble adapting to changes.
  • A hard time finding the right words.
  • Increased difficulty in doing tasks and activities that require organization and planning.

The main behavioral or psychological symptoms that make detecting dementia easier during primary care visits are:

  • Personality and mood changes.
  • Apathy, lack of motivation, and initiative.
  • Changes in behavior.
  • Psychiatric symptoms in people with no history of psychiatric problems.

The main functional symptoms are:

  • Difficulty completing normal tasks at home, work, or during leisure time.
  • Neglecting personal hygiene and self-care.
  • Withdrawal from work or social activities.
  • Difficulty managing money.

Evaluating and detecting dementia during primary care visits

The first medical professional that sees someone with signs of cognitive decline is their primary care physician. The first thing that primary care physicians do when they see a new patient is to get their medical history. In other words, they “interrogate” the patient and whoever is with them in order to learn about their symptoms and past illnesses and treatments.

During this interview, the physician systematically gathers data for a pathography of the patient (Redondo V. 2017). Among other things, the medical history includes when and how the disease started, how the patient believes it has evolved, and if they’ve noticed personality and/or behavioral changes, among other things. The result of this first examination is to make a diagnostic hypothesis.

A doctor talking with her patient.

Protocol for detecting dementia during primary care visits

In the guide Keys for Early Detection and Intervention of Dementia in Primary Care [translation] from Pastor, et al., your primary care physician should do the following:

  • Gather personal and family medical history, specifically related to neurological pathology, vascular infections, and traumatic brain injury, as well as psychiatric pathologies, comorbidities, and prescription drug use.
  • Perform a complete physical exam.
  • Do any important complementary testing. Analytic testing, neuroimaging tests, cognitive screening tools, and functional and neuropsychiatric evaluations.

In addition, once the primary care physician has done all of the above, they should also make the necessary referrals to neuropsychological, psychiatric, and geriatric specialists.

The goal of the referral is to confirm the dementia diagnosis and figure out what type of dementia the patient is suffering from. The specialists will also be able to do the right tests to get the patient on track for the appropriate treatment as quickly as possible.

In conclusion, holistic and personalized care is essential to properly diagnose an illness. That’s why multidisciplinary and interdisciplinary work is so important, especially in situations that can change a person’s life so drastically.

Arenillas, J. F., Arieta, E., Caballero, M. E., Domínguez, M. S., Lleras, S., Gómez, A., López, M. L., Martínez, N., Muñoz, J. L., Rodríguez, M. C., Rodríguez, C., Rubio, A., Trigueros, P., Tascón, M. M., y Vazquez, M. C. (2018). Claves para la detección y la intervención precoz de las demencias en atención primaria. Dirección General de Asistencia Sanitaria. Gerencia Regional de Salud

Contador, I., Fernández-Calvo, B., Ramos, F., Tapias-Merino, E., & Bermejo-Pareja, F. (2010). El cribado de la demencia en atención primaria. Revisión crítica. Revista de neurologia51(11), 677-686.

Pastor, M. Z., Del Ser, T., Laso, A. R., Yébenes, M. G., Domingo, J., & Puime, A. O. (2003). Demencia no detectada y utilización de los servicios sanitarios: implicaciones para la atención primaria. Atención primaria31(9), 581-586.